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Kapos FP, Gordon GO, Groenewald CB, Slack K, Wang V, Palermo TM, Wilson AC, Rabbitts JA. Prescription Opioid Decision-making and Use Behaviors in Adolescents With Acute Pain: A Qualitative Study. Clin J Pain 2024; 40:333-340. [PMID: 38347761 PMCID: PMC11087202 DOI: 10.1097/ajp.0000000000001205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 01/31/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVES Understanding adolescent perspectives on prescribed opioids in the context of medical care for acute pain is needed to prevent opioid-related adverse outcomes. We explored factors that may influence opioid decision-making and use behaviors among adolescents prescribed opioids for acute pain. METHODS We conducted semistructured interviews with 19 adolescents (63% females, ages 12 to 17) prescribed opioids upon discharge from surgery or intensive care unit admission. Interview transcripts were coded using inductive thematic analysis. RESULTS Five themes were identified: "Opioid use to reduce extreme pain and facilitate acute recovery"; "Familiarity with risks and negative effects of opioids"; "Assessment of opioid risk based on individual characteristics and use behaviors"; "Careful balance of risks, benefits, and symptoms when taking opioids"; "Importance of trusted adults for adolescent opioid management". Adolescents commonly believe opioids are only appropriate for severe pain that cannot be managed with other strategies. Most (but not all) adolescents were aware of addiction and other potential opioid harms and generally disapproved of misuse. However, a few adolescents would consider taking unprescribed opioids for severe pain. Adolescents wanted to be well informed for opioid decision-making, considering guidance from trusted adults. DISCUSSION Adolescents often demonstrated active and sound participation in shared opioid decision-making, influenced by complex integration of inputs and self-reflection. Conversely, potential factors that could contribute to risky behaviors included low personal risk perceptions, uncertainty about what constitutes opioid misuse, and avoidance of prescribed opioids despite extreme pain. Future studies may explore associations of adolescents' opioid decision-making with longer-term pain and opioid-related outcomes.
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Affiliation(s)
- Flavia P. Kapos
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, United States
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, United States
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, United States
| | - Grace O. Gordon
- Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, United States
- College of Arts and Sciences, University of Washington, Seattle, United States
| | - Cornelius B. Groenewald
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, United States
| | - Katherine Slack
- Elson S. Floyd College of Medicine, Washington State University, Spokane, United States
| | - Vienna Wang
- Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, United States
- College of Arts and Sciences, University of Washington, Seattle, United States
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, United States
| | - Tonya M. Palermo
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, United States
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, United States
| | - Anna C. Wilson
- Department of Pediatrics, Oregon Health & Science University, Portland, United States
| | - Jennifer A. Rabbitts
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, United States
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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.
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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
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Palomaa AK, Hakala M, Pölkki T. Parents' perceptions of their child's pain assessment in hospital care: A cross-sectional study. J Pediatr Nurs 2023; 71:79-87. [PMID: 37030017 DOI: 10.1016/j.pedn.2023.03.012] [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: 11/21/2022] [Revised: 03/23/2023] [Accepted: 03/23/2023] [Indexed: 04/10/2023]
Abstract
PURPOSE A prerequisite for successful pain management is identifying the pain and assessing its intensity. The aim of this study was to describe parents' perceptions of their child's pain assessment in hospital care. DESIGN AND METHODS This study was a descriptive cross-sectional study. A questionnaire was completed by parents (n = 261) whose child was hospitalized in one of the pediatric units (n = 6) of the University Hospital in Finland. Quantitative data were analyzed using statistical methods; open-ended data were analyzed using inductive content analysis. RESULTS Parents reported that their children experienced moderate (36%) to severe pain (42%) during hospitalization. The most intense pain experienced by the children was associated with needle-related procedures (41%). A large proportion of parents (83%) were involved in their child's pain assessment. Parents were satisfied with their child's pain assessment but perceived some shortcomings. Parents hoped that a variety of methods would be used to assess their child's pain and that the parents' and child's views on pain would be taken into account. CONCLUSIONS Most children experience moderate to severe pain during hospitalization. Parents are often involved in pain assessment but are rarely instructed to use pain scales. PRACTICE IMPLICATIONS Child's pain should be assessed regularly and frequently enough. It is important that the child and parents are involved in shared decision-making about pain assessment and treatment, and they have opportunities to ask questions. Guidance should be offered to parents about the use of pain assessment scales.
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Affiliation(s)
- Anna-Kaija Palomaa
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu, University Hospital and University of Oulu, Oulu, Finland; Oulu University Hospital, Oulu, Finland.
| | - Mervi Hakala
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu, University Hospital and University of Oulu, Oulu, Finland; Oulu University Hospital, Oulu, Finland
| | - Tarja Pölkki
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu, University Hospital and University of Oulu, Oulu, Finland; Oulu University Hospital, Oulu, Finland
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Bakir E, Briggs M, Mackintosh-Franklin C, Marshall M. Interactions between children, parents and nurses during postoperative pain management: A grounded theory study. J Clin Nurs 2023; 32:558-573. [PMID: 35383409 DOI: 10.1111/jocn.16318] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/16/2022] [Accepted: 03/18/2022] [Indexed: 01/17/2023]
Abstract
AIM To explore the interactions between children, parents and nurses during postoperative pain management. BACKGROUND Despite the growing evidence relating to postoperative pain management in children and relevant practice guidelines, children still experience moderate to severe pain after surgery. One factor could be related to the relatively unexplored child-parent-nurse interaction. DESIGN A qualitative constructivist grounded theory methodology. METHODS Data were collected from a paediatric hospital in the United Kingdom. Ten children aged between 6 and 11 years old who had undergone surgery, 11 parents and 10 nurses participated. Methods included face-to-face semi-structured interviews. Data were analysed using constant comparison technique, memos and constructivist grounded theory coding levels. The COREQ guidelines were followed for reporting. FINDINGS Three concepts emerged from data, "Parents as a communicator for child-nurse interaction", "Parents' emotional turmoil in child-nurse interaction", and "Parents' actions in child-nurse interaction" which constructed the substantive theory of child-parent-nurse interaction during postoperative pain management: "Facilitating or Inhibiting Interactions: Parental Influence on Postoperative Pain Management". The findings highlight an absence of a three-way interaction between children, parents and nurses and a dyadic interaction process between children and nurses was not apparent. Instead, child-parent-nurse interactions were constructed around two dyads of child-parent and parent-nurse interactions with child-nurse interaction constructed via parents. Parents, as a communicator, influenced the entire postoperative pain management processes between children, parents and nurses by facilitating or inhibiting the interaction processes. CONCLUSIONS This study identifies potentially important evidence about the unique position parents hold between their child and nurses as a central pivotal communicator during children's postoperative pain management. RELEVANCE TO CLINICAL PRACTICES This study may help to explain how and why postoperative pain management remains suboptimal. The substantive theory could support improvements in the management of postoperative pain through a much wider recognition of parents' central pivotal communicator role and the complexity of these child-nurse interactions.
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Affiliation(s)
- Ebru Bakir
- Department of Pediatric Nursing, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
| | - Michelle Briggs
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Carolyn Mackintosh-Franklin
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Marie Marshall
- Manchester University NHS Foundation Trust, Manchester, UK
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Saigh FI, Saigh ZI. Mothers' Involvement in Pediatric Postoperative Pain Care in a Tertiary Healthcare Setting in Saudi Arabia. Cureus 2023; 15:e34967. [PMID: 36938286 PMCID: PMC10019376 DOI: 10.7759/cureus.34967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 02/16/2023] Open
Abstract
Background Many children feel moderate to intense pain in the hospital following surgery. Untreated pain can have deleterious physical and psychological effects. Mothers' involvement in child pain care and management postoperatively has been shown to be important in improving the outcomes and experiences of children, mothers, and health professionals. Aims To explore mothers' involvement in postoperative pain care and management of their children during hospitalization and following discharge and identify approaches to improve management and participation activities. Methods We used a qualitative single case study design with thematic analysis. The analysis included 20 mother-child dyads and 21 nurses, involving observation of participants and semi-structured interviews of mothers and nurses. The analysis also incorporated a review of documents from the pediatric surgical department (hospital policies and forms). Findings The following main themes and sub-themes were generated from the data: (i) provision of pain information (expected type, frequency, and duration of pain after surgery, pain intensity score, pain relief medication, and pain management methods), (ii) communication deficiency (language barrier and breakdown in communication between health professionals), (iii) emotional and physical support (family support, environmental comfort, and sleep and meal requirements), (iv) social and cultural influences (patriarchal society, cultural and religious beliefs, and work status), and (v) hospital facilities, provisions, and services (entertainment, follow-up programs, education courses on pain management for nurses, and materials and services). Conclusions The study examined mothers' participation in postoperative pain care and management in a cohort of children admitted to a tertiary care setting in Saudi Arabia, highlighting key factors that influence involvement and suggesting approaches for improving participation.
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Affiliation(s)
- Fatmah I Saigh
- Oncology and Palliative Care, King Abdullah Medical Complex, Jeddah, SAU
| | - Zainab I Saigh
- Clinical Psychology, Mental Health Hospital in Jeddah, Jeddah, SAU
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Çaksen H. The Effects of Quran Recitation on Sedation and Pain in Children. J Pediatr Intensive Care 2023. [DOI: 10.1055/s-0042-1760632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Hüseyin Çaksen
- Divisions of Pediatric Neurology and Genetics, and Behavioral-Developmental Pediatrics Department of Pediatrics, Meram Medical Faculty, Necmettin Erbakan University, Meram, Konya, Türkiye
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Wozney L, Vakili N, Chorney J, Clark A, Hong P. The Impact of a Text Messaging Service (Tonsil-Text-To-Me) on Pediatric Perioperative Tonsillectomy Outcomes: Cohort Study With a Historical Control Group. JMIR Perioper Med 2022; 5:e39617. [PMID: 36125849 PMCID: PMC9533209 DOI: 10.2196/39617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Tonsillectomy is a common pediatric surgical procedure performed in North America. Caregivers experience complex challenges in preparing for their child's surgery and coordinating care at home and, consequently, could benefit from access to educational resources. A previous feasibility study of Tonsil-Text-To-Me, an automated SMS text messaging service that sends 15 time-sensitive activity reminders, links to nutrition and hydration tips, pain management strategies, and guidance on monitoring for complications, showed promising results, with high levels of caregiver satisfaction and engagement. OBJECTIVE This study aimed to pilot-test Tonsil-Text-To-Me in a real-world context to determine whether and how it might improve perioperative experiences and outcomes for caregivers and patients. METHODS Caregivers of children aged 3 to 14 years undergoing tonsillectomy were included. Data from a historical control group and an intervention group with the same study parameters (eg, eligibility criteria and surgery team) were compared. Measures included the Parenting Self-Agency Measure, General Health Questionnaire-12, Parents' Postoperative Pain Measure, Client Satisfaction Questionnaire-8, and engagement analytics, as well as analgesic consumption, pain, child activity level, and health service use. Data were collected on the day before surgery, 3 days after surgery, and 14 days after surgery. Participants in the intervention group received texts starting 2 weeks before surgery up to the eighth day after surgery. Descriptive and inferential statistics were used. RESULTS In total, 51 caregivers (n=32, 63% control; n=19, 37% intervention) who were predominately women (49/51, 96%), White (48/51, 94%), and employed (42/51, 82%) participated. Intervention group caregivers had a statistically significant positive difference in Parenting Self-Agency Measure scores (P=.001). The mean postoperative pain scores were higher for the control group (mean 10.0, SD 3.1) than for the intervention group (mean 8.5, SD 3.7), both of which were still above the 6/15 threshold for clinically significant pain; however, the difference was not statistically significant (t39=1.446; P=.16). Other positive but nonsignificant trends for the intervention group compared with the control group were observed for the highest level of pain (t39=0.882; P=.38), emergency department visits (χ22=1.3; P=.52; Cramer V=0.19), and other measures. Engagement with resources linked in the texts was moderate, with all but 1 being clicked on for viewing at least once by 79% (15/19) of the participants. Participants rated the intervention as highly satisfactory across all 8 dimensions of the Client Satisfaction Questionnaire (mean 29.4, SD 3.2; out of a possible value of 32.0). CONCLUSIONS This cohort study with a historical control group found that Tonsil-Text-To-Me had a positive impact on caregivers' perioperative care experience. The small sample size and unclear impacts of COVID-19 on the study design should be considered when interpreting the results. Controlled trials with larger sample sizes for evaluating SMS text messaging interventions aimed to support caregivers of children undergoing tonsillectomy surgery are warranted.
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Affiliation(s)
- Lori Wozney
- Mental Health and Addictions, Policy and Planning, Nova Scotia Health, Dartmouth, NS, Canada
| | - Negar Vakili
- Centre for Research in Family Health, IWK Health Centre, Halifax, NS, Canada
| | - Jill Chorney
- Mental Health and Addictions, IWK Health, Halifax, NS, Canada
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Alexander Clark
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Paul Hong
- Division of Otolaryngology, IWK Health, Halifax, NS, Canada
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
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Forster EM, Kotzur C, Richards J, Gilmour J. Paediatric post-discharge pain and parent perceptions of support from an Australian nurse practitioner led acute pain service. J Child Health Care 2022; 26:394-406. [PMID: 33940942 DOI: 10.1177/13674935211014742] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Poorly managed post-operative pain remains an issue for paediatric patients. Post-discharge telephone follow-up is used by an Australian Nurse Practitioner Acute Pain Service (NpAPS) to provide access to effective pain management post-discharge from hospital. This cross-sectional survey design study aimed to determine the pain levels of children following discharge and parent views on participation in their child's pain management and perceptions of support from the NpAPS. Parents completed the Parents' Postoperative Pain Measure-Short Form (PPPM-SF) and factors affecting parents' participation in children's pain management questionnaire (FPMQ). Results indicated that pain score was high, especially on the day of discharge and 24 hours post-discharge. Parents, despite feeling supported by the NpAPS, experienced uncertainty, emotional responses and expressed concerns about communication and coordination of care. The clinically significant pain levels of the majority of children on the day of discharge and day post-discharge from hospital are a concern. Worry and uncertainty among parents, particularly on the day and first night of discharge, suggest this transition period where responsibility of clinical management of pain is handed over to parents may require greater focus for parental support.
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Affiliation(s)
| | - Catherine Kotzur
- Department of Anaesthetics, 94273Queensland Children's Hospital, Brisbane
| | - Julianne Richards
- Department of Anaesthetics, 94273Queensland Children's Hospital, Brisbane
| | - John Gilmour
- School of Psychology, University of Southern Queensland, Australia
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Matula ST, Irving SY, Deatrick JA, Steenhoff AP, Polomano RC. The perceptions and practices of parents and children on acute pain management among hospitalized children in two Botswana referral hospitals. J Pediatr Nurs 2022; 65:e35-e42. [PMID: 35190237 DOI: 10.1016/j.pedn.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/23/2022] [Accepted: 02/10/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Perceptions and practices of parties in pediatric pain are critical in children's access to adequate acute pain management. The personal factors of the child and parents have been shown to be central to pediatric pain management by the Symptom Management Theory. AIM To describe children and parents/guardians' perceptions (knowledge, attitudes and beliefs) and practices regarding pediatric acute pain management and explain the influence of socio-cultural and environmental factors on those perceptions and practices. METHODS Descriptive cross-sectional survey using modified versions of the American Pain Society Patient Outcome Questionnaire-Revised among parents/guardians and children. RESULTS A convenience sample of 275 parents/guardians and 42 children aged 8 to 13 years admitted between date November 2018 and February 2019 to two Botswana tertiary hospitals completed the surveys. Forty-seven percent (n = 129) of parents/guardians reported the child to be in moderate-severe pain, while 38% (n = 16) of children reported pain as moderate-severe at the time of the survey. The children mean scores for cm-APS-POQ-R were 113(33) while parents/guardian's guardians for m-APS-POQ-R were 123(26). The subscales except for the parents/'guardians' pain interference (p = .96) were statistically significant (p = .000), showing adequate knowledge, positive attitudes and high pain intensity for both parents/guardians and children. CONCLUSION Parent/guardians and children reported a high incidence of acute pain, were content with pain management services, and showed adequate knowledge of pediatric pain and its management. The incongruence between the intensity of pain, satisfaction on the adequacy of pain management and knowledge and attitudes demonstrated in this study need further inquiry.
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Affiliation(s)
- Samuel T Matula
- Faculty of Health Sciences, School of Nursing, University of Botswana, Gaborone, Botswana; University of Botswana, Block 246/A106, 4775 Notwane Road, Gaborone, Botswana. P/bag UB, 00712, Gaborone, Botswana.
| | - Sharon Y Irving
- Pediatric Nursing, University of Pennsylvania, Nurse Practitioner, Division of Anesthesiology and Critical Care Medicine/Critical Care Nursing. The Children's Hospital of Philadelphia.
| | | | - Andrew P Steenhoff
- Perelman School of Medicine, University of Pennsylvania; Medical Director, Global Health Center, The Children's Hospital of Philadelphia; & Adjunct Senior Lecturer, Department of Paediatric and Adolescent Health, Faculty of Medicine, University of Botswana.
| | - Rosemary C Polomano
- Professor of Pain Practice, School of Nursing, Professor of Anesthesiology and Critical Care, Perelman School of Medicine.
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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.
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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]
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Assessment of Saudi Mothers' Attitudes towards Their Children's Pain and Its Management. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18010348. [PMID: 33466456 PMCID: PMC7796466 DOI: 10.3390/ijerph18010348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/31/2020] [Accepted: 01/01/2021] [Indexed: 12/03/2022]
Abstract
Background and objective: Pain is a bothersome issue that is common among newborns and children of all ages. Pain can be managed using various pharmacological and/or non-pharmacological strategies, which can be delivered by healthcare providers or parents. The aim of this study is to assess the attitude of mothers toward their children’s pain and its management. Methods and materials: A descriptive cross-sectional web-based study was conducted using a developed self-reported questionnaire, from March 2018 to April 2018. Participants involved were Arabic-speaking mothers of children aged between 0 and 12. The data collected included pharmacological and non-pharmacological treatment methodologies utilized to treat pain and the mothers’ attitude towards pain management. Statistical Package for Social Sciences, version 25 was applied to analyze the data, and descriptive statistics were performed. Results: As per the results of this study, the most common site of children’s pain as reported by the mothers was mouth/throat (211; 52.9%), abdomen (199; 49.9%), followed by head (58; 14.5%), and finally, ears (69; 17.3%). The frequency of children’s pain, as stated by the mothers, was less than once a month (196; 49.1%), once in a month (137; 34.3%), and once in a week (48; 12%). The non-pharmacological methods used by mothers at home for the management of their children’s pain were as follows: letting them take rest or sleep (250; 62.6%), feeding them with fluids (228; 57.1%), applying cold packs (161; 40.4%), providing massage therapy (147; 36.8%), using warm packs (141; 35.3%), and taking them to play (119; 29.8%). Conclusion: The misconceptions about pediatric pain management among Saudi mothers that can affect the children’s quality of life are quite noticeable. Implementing educational and awareness programs about the management of child pain could play a major role in making the parents understand the impacts of their misconceptions.
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Kelley-Quon LI, Kirkpatrick MG, Ricca RL, Baird R, Harbaugh CM, Brady A, Garrett P, Wills H, Argo J, Diefenbach KA, Henry MCW, Sola JE, Mahdi EM, Goldin AB, St Peter SD, Downard CD, Azarow KS, Shields T, Kim E. Guidelines for Opioid Prescribing in Children and Adolescents After Surgery: An Expert Panel Opinion. JAMA Surg 2021; 156:76-90. [PMID: 33175130 PMCID: PMC8995055 DOI: 10.1001/jamasurg.2020.5045] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
IMPORTANCE Opioids are frequently prescribed to children and adolescents after surgery. Prescription opioid misuse is associated with high-risk behavior in youth. Evidence-based guidelines for opioid prescribing practices in children are lacking. OBJECTIVE To assemble a multidisciplinary team of health care experts and leaders in opioid stewardship, review current literature regarding opioid use and risks unique to pediatric populations, and develop a broad framework for evidence-based opioid prescribing guidelines for children who require surgery. EVIDENCE REVIEW Reviews of relevant literature were performed including all English-language articles published from January 1, 1988, to February 28, 2019, found via searches of the PubMed (MEDLINE), CINAHL, Embase, and Cochrane databases. Pediatric was defined as children younger than 18 years. Animal and experimental studies, case reports, review articles, and editorials were excluded. Selected articles were graded using tools from the Oxford Centre for Evidence-based Medicine 2011 levels of evidence. The Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument was applied throughout guideline creation. Consensus was determined using a modified Delphi technique. FINDINGS Overall, 14 574 articles were screened for inclusion, with 217 unique articles included for qualitative synthesis. Twenty guideline statements were generated from a 2-day in-person meeting and subsequently reviewed, edited, and endorsed externally by pediatric surgical specialists, the American Pediatric Surgery Association Board of Governors, the American Academy of Pediatrics Section on Surgery Executive Committee, and the American College of Surgeons Board of Regents. Review of the literature and guideline statements underscored 3 primary themes: (1) health care professionals caring for children who require surgery must recognize the risks of opioid misuse associated with prescription opioids, (2) nonopioid analgesic use should be optimized in the perioperative period, and (3) patient and family education regarding perioperative pain management and safe opioid use practices must occur both before and after surgery. CONCLUSIONS AND RELEVANCE These are the first opioid-prescribing guidelines to address the unique needs of children who require surgery. Health care professionals caring for children and adolescents in the perioperative period should optimize pain management and minimize risks associated with opioid use by engaging patients and families in opioid stewardship efforts.
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Affiliation(s)
- Lorraine I Kelley-Quon
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California
- Department of Preventive Medicine, University of Southern California, Los Angeles
- Keck School of Medicine, Department of Surgery, University of Southern California, Los Angeles
| | | | - Robert L Ricca
- Department of Pediatric Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia
| | - Robert Baird
- Division of Pediatric Surgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Ashley Brady
- Department of Pediatric Surgery, University of Michigan, Ann Arbor
| | - Paula Garrett
- Department of Pediatric Surgery, University of Michigan, Ann Arbor
| | - Hale Wills
- Division of Pediatric Surgery, Hasbro Children's Hospital, Providence, Rhode Island
- Department of Surgery, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Jonathan Argo
- Department of Pediatric Anesthesiology, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Karen A Diefenbach
- Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus
| | - Marion C W Henry
- Department of Surgery, University of Arizona College of Medicine, Tucson
| | - Juan E Sola
- Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Elaa M Mahdi
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California
- Keck School of Medicine, Department of Surgery, University of Southern California, Los Angeles
| | - Adam B Goldin
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, Washington
- Department of Surgery, University of Washington School of Medicine, Seattle
| | - Shawn D St Peter
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Cynthia D Downard
- Division of Pediatric Surgery, Hiram C. Polk Jr MD Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Kenneth S Azarow
- Division of Pediatric Surgery, Department of Surgery, Oregon Health & Science University, Portland
| | - Tracy Shields
- Division of Library Services, Naval Medical Center, Portsmouth, Virginia
| | - Eugene Kim
- Division of Pain Medicine, Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, California
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Inpatient postoperative undesirable side effects of analgesics management: a pediatric patients and parental perspective. Pain Rep 2020; 5:e845. [PMID: 33134749 PMCID: PMC7467456 DOI: 10.1097/pr9.0000000000000845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/03/2020] [Accepted: 07/09/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction The use of analgesics for the treatment of post-operative pain is common, however, such medications are known to have potential side effects. These undesirable secondary effects can have an important impact on patients and impede their recovery. Objectives A review of the literature was conducted in order to gain a better understanding of the challenges confronted by pediatric patients in the acute post-operative period in terms of the side effects of analgesics. Methods An online search of keywords (pediatric, analgesic, pain medication, side effects, adverse effects, nausea and vomiting, post-operative, post-discharge, self-care, self-management, management, self-care strategies, patient expectations, patient concerns and education) using PubMed, Medline and Scopus databases, and using the snowballing method of reference tracking was conducted. Results A total of 10 studies (N = 10, 871 participants) published between 1990 and 2019 were reviewed. Common side effects experienced by patients were nausea, vomiting, and pruritus. Patients' parents reported having many concerns about analgesic use and reported a lack of knowledge on pain medications and side-effect management. Conclusion Areas of improvement in clinical practice include providing the patient and their parents with more information about the post-operative period, analgesic use, and side effects as well as prescribing appropriate treatments to alleviate side effects. This review reveals a lack of qualitative data on pain management and related undesired side effects in pediatric patients having undergone inpatient surgery in addition to the consequences on patients' daily living and on the self-care strategies they engage in to attenuate such effects.
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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.
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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.
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16
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Sundal H, Vatne S. Parents' and nurses' ideal collaboration in treatment-centered and home-like care of hospitalized preschool children - a qualitative study. BMC Nurs 2020; 19:48. [PMID: 32536810 PMCID: PMC7285722 DOI: 10.1186/s12912-020-00445-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 06/04/2020] [Indexed: 11/28/2022] Open
Abstract
Background The hospitalization of children requires collaboration between parents and nurses in partnerships. This study examines parents’ and nurses’ experiences of ideal collaboration in treatment-centered and home-like care of hospitalized preschool children. Methods This qualitative study is part of a larger study of 12 parents and 17 nurses who were responsible for 11 hospitalized children. Data collection took place at a Norwegian general paediatric unit, and the data were gathered from observations of and qualitative interviews with the parents and nurses. The analysis was conducted in six steps, in alignment with Braun and Clarke. Results Two essential themes emerged from the analysis. (1) Treatment-centered care focuses on the following tasks in building relationships – gaining trust, securing – gaining voluntariness, distracting and comforting, and securing and gaining voluntariness. The purpose of treatment-centered care is to perform diagnostic procedures and offer treatment. (2) Home-like care, the purpose of which is to manage a child’s everyday situations in an unfamiliar environment, focuses on the following tasks: making familiar meals, maintaining normal sleeping patterns, adjusting to washing and dressing in new situations, and normalizing the time in between. From this pattern, we chose two narratives that capture the essence of ideal collaboration between parents and nurses. Conclusion The ideal collaboration between nurses and parents is characterized by flexibility and reciprocity, and is based on verbal and action dialogues. In treatment-centered care, parent-nurse collaboration was successful in its flow and dynamic, securing the children’s best interests. Meanwhile, the achievement of the children’s best interest within home-like care varied according to the level of collaboration, which in turn was related to the complexity of the children’s everyday situations.
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Affiliation(s)
- Hildegunn Sundal
- Molde University College Specialized University in Logistics, Faculty of Health Sciences and Social Care, Molde, Norway
| | - Solfrid Vatne
- Molde University College Specialized University in Logistics, Faculty of Health Sciences and Social Care, Molde, Norway
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17
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Vasey J, Smith J, Kirshbaum MN, Chirema K. Tokenism or true partnership: Parental involvement in a child's acute pain care. J Clin Nurs 2019; 28:1491-1505. [PMID: 30549357 DOI: 10.1111/jocn.14747] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 10/25/2018] [Accepted: 11/30/2018] [Indexed: 12/21/2022]
Abstract
AIMS AND OBJECTIVES To explore parental involvement in the child's acute pain care and establish ways in which parental preferences for involvement in their child's care can be identified, facilitated and enhanced by nurses. BACKGROUND Despite growing evidence supporting effective acute pain management in children and the availability of national and international practice guidelines, children still experience acute pain. Involving parents in their child's pain care has been identified as being a central tenet of pain management in children. DESIGN AND METHODS A qualitative study using an ethnographical approach with nonparticipant observation and follow-up semi-structured interviews was undertaken. Nurses (n = 14), parents (n = 41), grandparents (n = 2), other relative (n = 1) and children (n = 30) participated. The framework approach underpinned data analysis. Consolidated criteria for reporting qualitative research (COREQ) enabled comprehensive reporting of the study. RESULTS Three concepts emerged from the data: "parents as advocates for their child," "nurses promoting involvement and partnership" and "nurses unintentionally preventing involvement and partnership." Variations in the way parents were involved in their child's pain care were identified. Despite family-centred care being the dominant model of involving families in their child's care, evidence of this being implemented was limited. Parents attempted to advocate effective pain care for their child, whether or not they were supported by nurses. CONCLUSIONS Parental involvement in their child's acute pain care can improve the child's pain experience, reduce parental anxiety and increase parents' satisfaction in care. Nurses aspired to involve parents in pain care, but did not always enact this in practice. RELEVANCE FOR PRACTICE Children deserve optimum pain care, which includes parental involvement. Parental involvement underpinned by the principles of family-centred care was poorly implemented. Parents attempted to be involved and advocate for their child's pain care whether or not they were supported by nurses. An alternative approach for supporting parents to advocate in their child's acute pain care is offered, the "Partnership in Pain Care Model."
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Affiliation(s)
| | - Joanna Smith
- School of Healthcare, University of Leeds, West Yorkshire, UK
| | - Marilynne N Kirshbaum
- College of Nursing and Midwifery, Charles Darwin University, Darwin, Northern Territory, Australia
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18
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Zhu L, Chan WCS, Liam JLW, Xiao C, Lim ECC, Luo N, Cheng KFK, He HG. Effects of postoperative pain management educational interventions on the outcomes of parents and their children who underwent an inpatient elective surgery: A randomized controlled trial. J Adv Nurs 2018; 74:1517-1530. [DOI: 10.1111/jan.13573] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2018] [Indexed: 01/24/2023]
Affiliation(s)
- Lixia Zhu
- Department of Pharmacology; Yong Loo Lin School of Medicine; National University of Singapore; Singapore Singapore
- National University Health System; Singapore Singapore
| | - Wai-Chi Sally Chan
- School of Nursing and Midwifery; Faculty of Health and Medicine; The University of Newcastle; Callaghan NSW Australia
| | - Joanne Li Wee Liam
- Division of Nursing; KK Women's and Children's Hospital; Singapore Singapore
| | | | | | - Nan Luo
- Saw Swee Hock School of Public Health; National University of Singapore; National University Health System; Singapore Singapore
| | - Kin Fong Karis Cheng
- National University Health System; Singapore Singapore
- Alice Lee Centre for Nursing Studies; Yong Loo Lin School of Medicine; National University of Singapore; Singapore Singapore
| | - Hong-Gu 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
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19
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Song JSA, Wozney L, Chorney J, Ishman SL, Hong P. Design and validation of key text messages (Tonsil-Text-To-Me) to improve parent and child perioperative tonsillectomy experience: A modified Delphi study. Int J Pediatr Otorhinolaryngol 2017; 102:32-37. [PMID: 29106872 DOI: 10.1016/j.ijporl.2017.08.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 08/24/2017] [Accepted: 08/24/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Parents can struggle while providing perioperative tonsillectomy care for their children at home. Short message service (SMS) technology is an accessible and direct modality to communicate timely, evidence-based recommendations to parents across the perioperative period. This study focused on validating a SMS protocol, Tonsil-Text-To-Me (TTTM), for parents of children undergoing tonsillectomy. METHODS This study used a modified Delphi expert consensus method. Participants were an international sample of 27 clinicians/researchers. Participants rated level of agreement with recommendations across seven perioperative domains, derived systematically from scientific and lay literature. A priori consensus analysis was conducted using threshold criterion. A multidisciplinary team of local clinicians were also individually interviewed to consolidate text messages and implement recurrent suggestions. RESULTS In the modified Delphi panel, 30 statements reached threshold agreement (>3.0 of 4.0); recommendations surrounding diet (3.87) and hygiene (3.83) had the highest level of consensus, while recommendations regarding activity (3.42) and non-pharmacologic pain management (3.55) had the lowest consensus. The 30 statements reconfigured into 12 concise text messages. After further interviews with local clinicians, 14 final text messages were included in the SMS protocol to be sent two weeks preoperatively to one week postoperatively. CONCLUSION This study illustrates the development of TTTM which is designed to deliver key sequential text messages at the optimal time during the perioperative setting to parents caring for their children who are undergoing tonsillectomy.
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Affiliation(s)
- Jin Soo A Song
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lori Wozney
- Centre for Research in Family Health, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Jill Chorney
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Stacey L Ishman
- Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati, Cincinnati, OH, United States
| | - Paul Hong
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
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20
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Wozney L, Chorney J, Huguet A, Song JS, Boss EF, Hong P. Online Tonsillectomy Resources: Are Parents Getting Consistent and Readable Recommendations? Otolaryngol Head Neck Surg 2017; 156:844-852. [PMID: 28195825 DOI: 10.1177/0194599817692529] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective Parents frequently refer to information on the Internet to confirm or broaden their understanding of surgical procedures and to research postoperative care practices. Our study evaluated the readability, comprehensiveness, and consistency around online recommendations directed at parents of children undergoing tonsillectomy. Study Design A cross-sectional study design was employed. Setting Thirty English-language Internet websites. Subjects and Methods Three validated measures of readability were applied and content analysis was employed to evaluate the comprehensiveness of information in domains of perioperative education. Frequency effect sizes and percentile ranks were calculated to measure dispersion of recommendations across sites. Results The mean readability level of all sites was above a grade 10 level with fewer than half of the sites (n = 14, 47%) scoring at or below the eight-grade level. Provided information was often incomplete with a noted lack of psychosocial support and skills-training recommendations. Content analysis showed 67 unique recommendations spanning the full perioperative period. Most recommendations had low consensus, being reported in 5 or fewer sites (frequency effect size <16%). Conclusion Many online parent-focused resources do not meet readability recommendations, portray incomplete education about perioperative care and expectations, and provide recommendations with low levels of consensus. Up-to-date mapping of the research evidence around recommendations is needed as well as improved efforts to make online information easier to read.
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Affiliation(s)
- Lori Wozney
- 1 Centre for Research in Family Health, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Jill Chorney
- 2 Pediatric Research in Perioperative Care Lab, IWK Health Centre, Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,3 Department of Surgery, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anna Huguet
- 1 Centre for Research in Family Health, IWK Health Centre, Halifax, Nova Scotia, Canada.,4 Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jin Soo Song
- 3 Department of Surgery, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Emily F Boss
- 5 Departments of Otolaryngology-Head and Neck Surgery and Health Policy and Management, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Paul Hong
- 2 Pediatric Research in Perioperative Care Lab, IWK Health Centre, Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,3 Department of Surgery, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
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21
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Sng QW, He HG, Wang W, Taylor B, Chow A, Klainin-Yobas P, Zhu L. A Meta-Synthesis of Children's Experiences of Postoperative Pain Management. Worldviews Evid Based Nurs 2016; 14:46-54. [DOI: 10.1111/wvn.12185] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2016] [Indexed: 02/02/2023]
Affiliation(s)
- Qian Wen Sng
- Staff Nurse, Division of Nursing; KK Women's and Children's Hospital; Singapore
| | - Hong-Gu He
- Associate Professor, Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine; National University of Singapore; Singapore
| | - Wenru Wang
- Assistant Professor, Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine; National University of Singapore; Singapore
| | - Beverley Taylor
- Professor, School of Nursing and Midwifery, Gippsland Campus; Monash University; Australia
| | - Aloysius Chow
- Research Assistant, Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine; National University of Singapore; Singapore
| | - Piyanee Klainin-Yobas
- Associate Professor, Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine; National University of Singapore; Singapore
| | - Lixia Zhu
- Research Fellow, Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine; National University of Singapore; Singapore
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22
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Neglect of Postoperative Pain Management in Children: A Qualitative Study Based on the Experiences of Parents. J Pediatr Nurs 2016; 31:439-48. [PMID: 27033024 DOI: 10.1016/j.pedn.2016.02.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 02/23/2016] [Accepted: 02/29/2016] [Indexed: 12/17/2022]
Abstract
UNLABELLED Identifying parents' experiences of barriers to optimal postoperative pain management in children. DESIGN AND METHODS This qualitative-content analysis study was conducted with 16 parents whose school-age children had undergone emergency abdominal surgery in university hospitals of Ahvaz, southern Iran. A purposive sampling method was used to select the participants. The semi-structured interviews with all of the participants were recorded, transcribed, and analysed. RESULTS After data analysis, neglect emerged as the main theme. This neglect consisted of three categories including the healthcare system's disregard, insufficient sensitivity of the healthcare providers, and hesitance or delays of parents and children in asking for care. CONCLUSION The optimal management of children's postoperative pain requires the provision of relevant infrastructures by the healthcare system, responsible performance of the health professionals beyond the routine, and active and informed participation of both parents and children.
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Yang JY, Lee H, Zhang Y, Lee JU, Park JH, Yun EK. The Effects of Tonsillectomy Education Using Smartphone Text Message for Mothers and Children Undergoing Tonsillectomy: A Randomized Controlled Trial. Telemed J E Health 2016; 22:921-928. [PMID: 27192359 DOI: 10.1089/tmj.2016.0019] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Tonsillectomy is the most common type of surgical procedure performed in preschool children. Due to short period of hospitalization, mothers are expected to manage their children's care at home. However, they are rarely provided with sufficient information about postoperative management. This study aims to determine the effectiveness of providing caregivers with information on tonsillectomy care by smartphone text messaging in increasing their mothers' knowledge, reducing the anxiety, and improving the sick-role behavior of pediatric tonsillectomy patients. MATERIALS AND METHODS A sample of 61 pediatric patients and their mothers was recruited. Participants were randomly assigned into either the experimental group (n = 27) or the control group (n = 34). The control group was given information about the tonsillectomy by conventional textual and verbal means, whereas the experimental group received the same information in the form of 10 text messages during the period from hospitalization to their first follow-up visits. RESULTS Results of mixed design, two-way analysis of variance indicated significant interaction effects between time points and groups for mothers' knowledge (F = 4.26, p = 0.043) and children's anxiety (F = 3.32; p = 0.037). Thus, the results do support the effectiveness of tonsillectomy education using smartphone text messaging in increasing mothers' knowledge and reducing children's anxiety. CONCLUSIONS These results can be applied to preoperative and postoperative interventions for children not only for tonsillectomy but also for many other operations. The development of various educational programs using smartphone text messaging for postoperative patient management would also be valuable.
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Affiliation(s)
- Ji Yeon Yang
- 1 Graduate School of Public Administration, Kyung Hee University , Seoul, Korea
| | - Hanna Lee
- 2 Department of Nursing, Graduate School, Kyung Hee University, Seoul, Korea
| | - Yongai Zhang
- 2 Department of Nursing, Graduate School, Kyung Hee University, Seoul, Korea
| | - Ji Uhn Lee
- 2 Department of Nursing, Graduate School, Kyung Hee University, Seoul, Korea
| | - Jun Hee Park
- 2 Department of Nursing, Graduate School, Kyung Hee University, Seoul, Korea
| | - Eun Kyoung Yun
- 3 College of Nursing Science, Kyung Hee University, Seoul, Korea
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24
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Experiences of Iranian Nurses on the Facilitators of Pain Management in Children: A Qualitative Study. PAIN RESEARCH AND TREATMENT 2016; 2016:3594240. [PMID: 27123342 PMCID: PMC4829710 DOI: 10.1155/2016/3594240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 02/20/2016] [Accepted: 03/06/2016] [Indexed: 11/18/2022]
Abstract
Background. Despite decades of research and the availability of effective analgesic approaches, many children continue to experience moderate-to-severe pain after hospitalization. Greater research efforts are needed to identify the factors that facilitate effective pain management. The aim of this study was to explore the perceptions of Iranian nurses on facilitators of pain management in children. Materials and Methods. This qualitative study collected the data profoundly through unstructured interviews with 19 nurses in Amirkola Children's Hospital in Babol and Children's Medical Center in Tehran, during 2013-2014. Purposeful sampling and analysis of the data were conducted using conventional qualitative content analysis. Results. Four themes were extracted through data analysis: mother and child participation in diagnosis and pain relief, the timely presence of medical staff and parents, proper communication, and training and supportive role of nurses. Conclusion. Mother and child participation in the report and diagnosis of pain and nonpharmacological interventions for pain by the mother, the timely presence of medical team at the patient's bedside, and proper interaction along with the training and supportive role of a nurse enhanced the optimal pain management in hospitalized children.
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25
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Olshansky E, Zender R, Kain ZN, Rosales A, Guadarrama J, Fortier MA. Hispanic parents' experiences of the process of caring for a child undergoing routine surgery: a focus on pain and pain management. J SPEC PEDIATR NURS 2015; 20:165-77. [PMID: 25816910 DOI: 10.1111/jspn.12111] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 02/27/2015] [Accepted: 03/02/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose was to understand the processes Hispanic parents undergo in managing postoperative care of children after routine surgical procedures. DESIGN AND METHODS Sixty parents of children undergoing outpatient surgery were interviewed. Data were analyzed using grounded theory methodology. RESULTS Parents experienced five subprocesses that comprised the overall process of caring for a child after routine surgery: (a) becoming informed; (b) preparing; (c) seeking reassurance; (d) communicating with one's child; and (e) making pain management decisions. PRACTICE IMPLICATIONS Addressing cultural factors related to pain management in underserved families may instill greater confidence in managing pain.
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Affiliation(s)
- Ellen Olshansky
- Program in Nursing Science, University of California, Irvine, California, USA.,Community Engagement, Institute for Clinical and Translational Science, University of California, Irvine, California, USA
| | - Robynn Zender
- Institute for Clinical and Translational Science, University of California, Irvine, California, USA
| | - Zeev N Kain
- Department of Anesthesiology & Perioperative Care, University of California, Irvine School of Medicine, Irvine, California, USA
| | - Alvina Rosales
- Department of Anesthesiology & Perioperative, University of California, Irvine School of Medicine, Irvine, California, USA
| | | | - Michelle A Fortier
- Department of Anesthesiology & Perioperative Care, University of California, Irvine School of Medicine, Orange, California, USA
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Chng HY, He HG, Chan SWC, Liam JLW, Zhu L, Cheng KKF. Parents’ knowledge, attitudes, use of pain relief methods and satisfaction related to their children's postoperative pain management: a descriptive correlational study. J Clin Nurs 2015; 24:1630-42. [DOI: 10.1111/jocn.12764] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Hui Yi Chng
- Division of Nursing; KK Women's and Children's Hospital; Singapore Singapore
| | - Hong-Gu He
- Alice Lee Centre for Nursing Studies; Yong Loo Lin School of Medicine; National University of Singapore; Singapore Singapore
| | - Sally Wai-Chi Chan
- School of Nursing and Midwifery; Faculty of Health and Medicine; The University of Newcastle; Newcastle NSW Australia
| | - Joanne Li Wee Liam
- Division of Nursing; KK Women's and Children's Hospital; Singapore Singapore
| | - Lixia Zhu
- Alice Lee Centre for Nursing Studies; Yong Loo Lin School of Medicine; National University of Singapore; Singapore Singapore
| | - Karis Kin Fong Cheng
- Alice Lee Centre for Nursing Studies; Yong Loo Lin School of Medicine; National University of Singapore; Singapore Singapore
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He HG, Zhu L, Chan WCS, Xiao C, Klainin-Yobas P, Wang W, Cheng KFK, Luo N. A randomized controlled trial of the effectiveness of an educational intervention on outcomes of parents and their children undergoing inpatient elective surgery: study protocol. J Adv Nurs 2014; 71:665-75. [DOI: 10.1111/jan.12521] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2014] [Indexed: 01/22/2023]
Affiliation(s)
- Hong-Gu He
- Alice Lee Centre for Nursing Studies; National University of Singapore; Singapore
| | - Lixia Zhu
- Alice Lee Centre for Nursing Studies; National University of Singapore; Singapore
| | | | - Chunxiang Xiao
- Alice Lee Centre for Nursing Studies; National University of Singapore; Singapore
| | | | - Wenru Wang
- Alice Lee Centre for Nursing Studies; National University of Singapore; Singapore
| | - Kin Fong Karis Cheng
- Alice Lee Centre for Nursing Studies; National University of Singapore; Singapore
| | - Nan Luo
- Saw Swee Hock School of Public Health; National University of Singapore; Singapore
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28
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He HG, Klainin-Yobas P, Ang ENK, Sinnappan R, Pölkki T, Wang W. Nurses' provision of parental guidance regarding school-aged children's postoperative pain management: a descriptive correlational study. Pain Manag Nurs 2014; 16:40-50. [PMID: 24957816 DOI: 10.1016/j.pmn.2014.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Revised: 02/28/2014] [Accepted: 03/17/2014] [Indexed: 11/27/2022]
Abstract
Involving parents in children's pain management is essential to achieve optimal outcomes. Parents need to be equipped with sufficient knowledge and information. Only a limited number of studies have explored nurses' provision of parental guidance regarding the use of nonpharmacologic methods in children's pain management. This study aimed to examine nurses' perceptions of providing preparatory information and nonpharmacologic methods to parents, and how their demographics and perceived knowledge adequacy of these methods influence this guidance. A descriptive correlational study using questionnaire surveys was conducted to collect data from a convenience sample of 134 registered nurses working in seven pediatric wards of two public hospitals in Singapore. Descriptive statistics, independent-samples t test, and multiple linear regression were used to analyze the data. Most nurses provided various types of cognitive information to parents related to their children's surgery, whereas information about children's feelings was less often provided. Most nurses provided guidance to parents on positioning, breathing technique, comforting/reassurance, helping with activities of daily living, relaxation, and creating a comfortable environment. Nurses' provision of parental guidance on preparatory information and nonpharmacologic methods was significantly different between subgroups of age, education, parent or not, and perceived knowledge adequacy of nonpharmacologic methods. Nurses' perceived knowledge adequacy was the main factor influencing their provision of parental guidance. More attention should be paid to nurses who are younger, have less working experience, and are not parents. There is a need to educate nurses about nonpharmacologic pain relief methods to optimize their provision of parental guidance.
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Affiliation(s)
- Hong-Gu He
- Alice Lee Centre for Nursing Studies Department, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Piyanee Klainin-Yobas
- Alice Lee Centre for Nursing Studies Department, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Emily Neo Kim Ang
- Clinical and Oncology Nursing, National University Hospital, Singapore
| | | | - Tarja Pölkki
- Institute of Health Sciences, University of Oulu, Oulu, Finland
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies Department, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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A Delphi study to identify indicators of poorly managed pain for pediatric postoperative and procedural pain. Pain Res Manag 2014; 18:e68-74. [PMID: 24093121 DOI: 10.1155/2013/570478] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Adverse health care events are injuries occurring as a result of patient care. Significant acute pain is often caused by medical and surgical procedures in children, and it has been argued that undermanaged pain should be considered to be an adverse event. Indicators are often used to identify other potential adverse events. There are currently no validated indicators for undertreated pediatric pain. OBJECTIVES To develop a preliminary list of indicators of undermanaged pain in hospitalized pediatric patients. METHODS The Delphi technique was used to survey experts in pediatric pain management and quality improvement. The first round used an electronic questionnaire to ask: "In your opinion, what indicators would signify that acute pain in a child has not been adequately controlled?" Responses were grouped together in semantically similar themes, providing a list of possible adverse event indicators. Using this list, an electronic questionnaire was developed for round 2 asking respondents to indicate the importance of each potential indicator. RESULTS All but one indicator achieved a level of consensus ≥70%. Separate indicators emerged for postoperative and procedural pain. An additional distinction was made between indicators that could be identified by chart review and those requiring observation of practice and assessment from the child or parent. DISCUSSION The adverse care indicators developed in the present study require further refinement. There is a need to test their clinical usability and to determine whether these indicators actually identify undermanaged pain in clinical practice. The present study is an important first step in identifying undermanaged pain in hospital and treating it as an adverse event. CONCLUSION The adverse care indicators developed in the present study are the first step in conceptualizing mismanaged pain as an adverse event.
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Twycross A, Finley GA, Latimer M. Pediatric nurses' postoperative pain management practices: an observational study. J SPEC PEDIATR NURS 2013; 18:189-201. [PMID: 23822843 DOI: 10.1111/jspn.12026] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 01/24/2013] [Accepted: 01/28/2013] [Indexed: 01/17/2023]
Abstract
PURPOSE This study was an in-depth examination of pediatric postoperative pain care. DESIGN AND METHODS Participant observational data were collected on the care of 10 children. Particular attention was paid to actions when pain scores were ≥5 and to the relationship between pain scores and medications administered. RESULTS A pattern of care emerged of giving pain medications regularly even if they were prescribed pro re nata. Actions when pain scores were ≥5 varied. Recorded pain scores rarely guided treatment choices. PRACTICE IMPLICATIONS The use of pain scores to guide treatment choices needs further debate. Future research should explore the implications of divorcing treatment from pain scores on children's pain experience.
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Affiliation(s)
- Alison Twycross
- Faculty of Health, Social Care and Education, St George's University of London, London, United Kingdom.
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31
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Twycross A, Finley GA. Children's and parents’ perceptions of postoperative pain management: a mixed methods study. J Clin Nurs 2013; 22:3095-108. [DOI: 10.1111/jocn.12152] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2012] [Indexed: 12/26/2022]
Affiliation(s)
- Alison Twycross
- Faculty of Health, Social Care and Education; Kingston University and St George's University of London; London UK
| | - G Allen Finley
- Anesthesia & Psychology; Dalhousie University; Halifax NS Canada
- Dr Stewart Wenning Chair in Pediatric Pain Management; IWK Health Centre; Halifax NS Canada
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Sng QW, Taylor B, Liam JLW, Klainin-Yobas P, Wang W, He HG. Postoperative pain management experiences among school-aged children: a qualitative study. J Clin Nurs 2013; 22:958-68. [DOI: 10.1111/jocn.12052] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Qian Wen Sng
- Division of Nursing; KK Women's and Children's Hospital; Singapore
| | - Beverley Taylor
- School of Nursing and Midwifery; Monash University; Gippsland Victoria Australia
| | - Joanne LW Liam
- Division of Nursing; KK Women's and Children's Hospital; Singapore
| | - Piyanee Klainin-Yobas
- Alice Lee Centre for Nursing Studies; Yong Loo Lin School of Medicine; National University of Singapore; Singapore
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies; Yong Loo Lin School of Medicine; National University of Singapore; Singapore
| | - Hong-Gu He
- Alice Lee Centre for Nursing Studies; Yong Loo Lin School of Medicine; National University of Singapore; Singapore
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