Hispanic parents' experiences of the process of caring for a child undergoing routine surgery: a focus on pain and pain management

Communication, information, involvement and decision making: A systematic scoping review of child-parent-nurse relationships during postoperative pain management

AIMS

To examine the existing literature on child-parent-nurse relationships (in relation to communication, information, and involvement and decision-making) during postoperative pain management.

BACKGROUND

Pain in children is under-reported and under-treated in hospitals and research has continued to report high rates of pain among hospitalised children worldwide. The role of child-parent-nurse relationships may be a factor and to date, no review has been identified that focus on these relationships during postoperative pain management.

DESIGN

A systematic scoping review following Arksey and O'Malley with further adaptations based on JBI.

METHODS

A systematic search for published primary studies was conducted using the Medline, CINAHL, British Nursing Index, ASSIA, PsycINFO, Science Direct and Web of Science in English from 2000 to 2022. Two reviewers independently carried out data screening and extraction and any differences were resolved with the assistance of a third reviewer. The data were analysed using thematic analysis and presented descriptively. This study followed the PRISMA-ScR Checklist.

RESULTS

A total of 37 studies met the inclusion criteria. The findings mainly demonstrated a focus on the perspectives of parents and nurses with less on children's perspectives and none of the studies explored child-nurse relationships. The findings were categorised under three themes: communication, information, and involvement and decision making.

CONCLUSION

A prevailing deficiency in child-parent-nurse relationships significantly contributed to suboptimal postoperative pain care, causing prolonged and untreated postoperative pain in children. Children's hesitation in communicating with nurses, the limited communication skills of nurses, and the weak communication position of parents in a hospital setting all hindered the development of strong relationships between children, parents, and nurses. The unclear definition of the roles of children and parents in postoperative pain management resulted in confusion for both parents and nurses. This was exacerbated by parents' lack of knowledge and inadequate guidance from nurses, ultimately leading to a decreased level of parental involvement in their child's postoperative pain management while in the hospital. Unattended requests for pain management caused children to experience prolonged pain and led to a deterioration in the relationship between parents and nurses, as well as a reduction in the parents' ability to provide pain care to their child.

RELEVANCE TO CLINICAL PRACTICE

This study highlights the reasons behind the suboptimal management of postoperative pain in children. The importance of the relationship between children, parents, and nurses in pain management must be acknowledged, and the results of this study may be used to inform improvements in nursing pain management practices.

NO PATIENT OR PUBLIC CONTRIBUTION

Patient or public contribution is not a necessary stage in a systematic scoping review following Arksey and O'Malley's framework.

Interactions between children, parents and nurses during postoperative pain management: A grounded theory study

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.

To relieve pain or avoid opioid-related risk? A comparison of parents' analgesic trade-off preferences and decision-making in 2019 versus 2013 in a single U.S. pediatric hospital

BACKGROUND

Analgesic trade-off preferences, or the relative preference for pain relief vs. risk aversion, shape parents' decisions to give prescription opioids to their children. These preferences may be influenced by personal experiences and societal factors.

AIM

To examine whether parental analgesic trade-off preferences and opioid decision-making have shifted toward risk aversion during the opioid crisis in the United States.

METHODS

We conducted a secondary analysis of the preoperative survey data of parents from a single U.S. pediatric hospital whose children aged 5-17 years were to undergo painful surgery in 2013 (Time 1) or 2017/2019 (Time 2). Surveys assessed parents' analgesic trade-off preference (-12 or risk-averse to +12 or pain relief preferent, scores around 0=ambivalent) and their hypothetical decisions to give a prescribed opioid to a child in pain.

RESULTS

Data from 847 parents were included (Time 1, n = 361; Time 2, n = 486). Parents at Time 2 were significantly more risk-averse compared with Time 1 (adj.β: -0.84 [95% CI: -1.09, -0.60]). Parents at Time 2 were more than twice as likely to be risk-averse or ambivalent (OR: 2.17 [95% CI: 1.62, 2.91]). There was a significant interaction effect of Time*Preference on parents' decision to give the opioid (adj. OR: 1.09 [95% CI: 1.03, 1.16]). At Time 2, parents who were ambivalent or risk-averse were less likely than those who preferred to relieve pain to administer the prescribed opioid (OR: 0.57 [95% CI: 0.37, 0.89]). In contrast, there was no association between the preference group and the opioid decision at Time 1.

CONCLUSION

Findings suggest that parents of children scheduled for painful surgery at our pediatric hospital have become more analgesic risk-averse during the past decade. Parents' analgesic trade-off preferences may influence their decisions to administer prescribed opioids after surgery, which may contribute to children's pain outcomes.

Explaining the Care Experiences of Mothers of Children with Hirschsprung's Disease: A Qualitative Study

Hirschsprung’s disease is a gastrointestinal anomalies that disrupts excretion. In this disease, like other chronic diseases; mothers undergo a lot of care. Considering the concept of nursing care, it is important to understand the care and its effects on the parents, the child, and care improvement. The purpose of this study is to understand the care experiences of parents of children with Hirschsprung’s disease. In this qualitative study which was performed by content analysis approach, 12 participants were selected from mothers of children with Hirschsprung’s disease who were referred to pediatric surgeries through purposeful sampling. The data collection method was a half-structured interview. All interviews were recorded and then were handwritten word by word and data were analyzed using Elo and Kyngas qualitative content analysis method. Data analysis began from the time of the first interview and in parallel to the next interviews (simultaneous analysis). At the beginning, the first-level coding was done. Data analysis led to the emergence of 3 main themes: “erosion care, socio-economic challenges, acceptance, and position-matching,” and each of the themes included several sub-themes. The results of this study showed that parents of children with Hirschsprung despaired of concern and suffering from care which these suffers included physical, psychological, social, and material dimensions, but was also associated with satisfaction and acceptance of the disease. These findings emphasize that one of the most important tasks of nurses in clinical institutions, especially in relation to these children, is to provide proper family-centered care.

Postoperative pain: factors and tools to improve pain management in children

Outpatient surgery has made it increasingly common for parents to manage pain in the home setting. Studies have shown that parents often under treat pain, leaving children vulnerable to the negative side effects of suboptimal pain management. Multiple factors affect pain management like child’s age and developmental stage, language, cultural values like stoicism, parental beliefs about medication, biological differences among groups, etc. Understanding all the factors involved can help healthcare providers and parents better understand pain and contribute to optimal pain management. Multiple tools and technological interventions have been created to help create a better understanding of pain and a holistic approach to care.

Long-Term Pain and Recovery After Major Pediatric Surgery: A Qualitative Study With Teens, Parents, and Perioperative Care Providers

Research developing targeted treatment focused on coping with children's long-term pain after surgery is needed because of the high prevalence of chronic pain after surgery. This qualitative study aimed to: 1) understand the child's and family's experiences of pain over the course of their surgical experience, and 2) gather stakeholder input regarding potential barriers and facilitators of perioperative intervention delivery. Fifteen children ages 10 to 18 years who underwent recent major surgery, their primary caregivers, and 17 perioperative health care providers were interviewed. Interviews were coded using semantic thematic analysis. The perioperative period presented emotional challenges for families. Families felt unprepared for surgery and pain. Recovery and regaining physical functioning at home was challenging. Families struggled to return to valued activities. Families reported interest in a perioperative psychosocial intervention. Providers endorsed that families would benefit from enhanced coping skills. They emphasized that families would benefit from more detailed preparatory information. Providers suggested that flexible intervention delivery at home would be ideal. Research developing interventions addressing pain and anxiety in children undergoing major surgery is critically needed. The findings of the present study can inform intervention development with the aim of improving short- as well as long-term recovery in children undergoing major surgery.

PERSPECTIVE

This qualitative study examined children and their parents' experience of long-term pain and recovery after major surgery, identifying barriers and facilitators of perioperative intervention delivery. Families experienced surgery as stressful, and felt underprepared for pain and recovery. Families and health care providers expressed interest in a preoperative intervention teaching coping skills.

Community-based participatory research: an innovative approach for improving perioperative care of underserved children

Pediatric disparities disproportionately affect Latino youth undergoing surgery and their families. As such, there is a critical need for culturally relevant frameworks that can advance perioperative intervention approaches in this population and reduce these disparities. In the following article, we first describe the methodological process of community-based participatory research (CBPR) and next report the results of the CBPR process that was conducted in this population. An interdisciplinary group of investigators, Latina mothers, and various other stakeholders met for a series of CBPR-based structured meetings. Qualitative data collection and analyses of the CBPR process were guided by principles of grounded theory that employs inductive techniques and constant comparison analyses until reaching saturation of data. Barriers identified in the process can be grouped within the following domains: child-related factors, family-related factors, health care provider factors, and hospital system factors. Family system factors category (coded references = 136) had the highest number of coded references; this category was found to be best described by the value of familismo or familism, including a duty to help family members when in need. The health care provider category (coded references = 42) was ranked second by frequency. Within this category, two major themes surfaced: health care provider cultural competence and overestimating health literacy. All barriers identified will be next incorporated in an innovative behavioral intervention that is currently being developed. We conclude that the model of CBPR can be used within the context of perioperative care of children and their families.

Children's postoperative symptoms at home through nurse-led telephone counseling and its effects on parents' anxiety: A randomized controlled trial

PURPOSE

The objective of this study was to evaluate children's postoperative symptoms at home after outpatient surgery through nurse-led telephone counseling and the effects of the nurse-led telephone counseling on parents' state-trait anxiety scores.

DESIGN AND METHODS

In this prospective randomized controlled study, nurse-led telephone counseling was provided every day to parents in the intervention group until they came for the follow-up visit. Parents of children (n = 54) ages 3-17 years who had undergone outpatient surgery for appendicitis, cholecystectomy, or ovarian cysts were eligible to participate in the study. On the first postoperative day and at the follow-up visit, the Spielberger State-Trait-Anxiety Inventory (STAI) was administered to parents who were randomly allocated to the intervention (n = 24) and control groups (n = 30).

RESULTS

The parents reported on postoperative symptoms such as pain, activity levels, excretion, sleep, nutrition, and wound infection. While there was no difference in STAI scores for parents between the groups at the first postoperative day, there was a significant decrease in STAI scores in the intervention group versus the control group, with parents in the intervention group reporting lower anxiety scores.

PRACTICE IMPLICATIONS

Our results suggest that nurse-led telephone counseling is effective at reducing anxiety in parents of children after outpatient surgery.