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Moll-Bertó A, López-Rodrigo N, Montoro-Pérez N, Mármol-López MI, Montejano-Lozoya R. A Systematic Review of the Effectiveness of Non-Pharmacological Therapies Used by Nurses in Children Undergoing Surgery. Pain Manag Nurs 2024; 25:195-203. [PMID: 38233305 DOI: 10.1016/j.pmn.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 11/29/2023] [Accepted: 12/20/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVE The aim of this study was to identify non-pharmacological pain relief therapies in children undergoing surgery. DESIGN AND DATA SOURCES Using keywords extracted from Medical Subject Headings and "Descriptores en Ciencias de la Salud" we searched for articles in the Web of Science, Scopus, Cuiden, PubMed, and CINHAL databases from the last five years, and performed a reverse search. We assessed the documentary quality of the articles using various standardized instruments. RESULTS The final review included eleven studies. In terms of cognitive-behavioral techniques, there is evidence that both music and video therapy are effective in reducing postoperative pain in children in seven studies, and therapeutic play in five studies. Other methods used less frequently but found to be effective included laughter therapy in one study and deep breathing in another. Regarding physical methods of pain relief, massage was found to be an effective non-pharmacological therapy for reducing pediatric postoperative pain in two studies and ineffective in another. CONCLUSIONS In this study, we highlight the importance of non-pharmacological therapies in pediatric postoperative pain management. Cognitive-behavioral techniques, especially music therapy, video therapy, and therapeutic play, reduce pediatric postoperative pain. They are therefore effective therapies that nurses can use in this area. Further research into the effectiveness of storytelling is necessary, as the evidence is not entirely conclusive. More evidence is also needed on physical methods of pain relief, particularly massage.
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Affiliation(s)
- Andreu Moll-Bertó
- From the La Fe School of Nursing, Affiliated Center of the University of Valencia, Spain
| | - Nerea López-Rodrigo
- From the La Fe School of Nursing, Affiliated Center of the University of Valencia, Spain
| | - Néstor Montoro-Pérez
- Department of Nursing, Faculty of Health Sciences, Person-centred Care and Health Outcomes Innovation Group, University of Alicante, San Vicente del Raspeig, Spain; La Fe School of Nursing, Affiliated Center of the University of Valencia, Spain, GREIACC Research Group, La Fe Health Research Institute, Valencia, Spain.
| | - María Isabel Mármol-López
- La Fe School of Nursing, Affiliated Center of the University of Valencia, Spain, GREIACC Research Group, La Fe Health Research Institute, Valencia, Spain
| | - Raimunda Montejano-Lozoya
- La Fe School of Nursing, Affiliated Center of the University of Valencia, Spain, GREIACC Research Group, La Fe Health Research Institute, Valencia, Spain
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Rede FM, Goshu EM, muzien SJ. Severity and associated factors of postoperative pain in paediatric surgical patients aged 2 months-7 years at selected Addis Ababa Public Hospitals: a multicenter prospective longitudinal study. Ann Med Surg (Lond) 2024; 86:1275-1282. [PMID: 38463099 PMCID: PMC10923381 DOI: 10.1097/ms9.0000000000001742] [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: 08/29/2023] [Accepted: 01/08/2024] [Indexed: 03/12/2024] Open
Abstract
Background Postoperative pain is a common and distressing consequence of surgery in children. It can lead to suffering, prolonged recovery, impaired physical functioning, and even chronic pain. Effective postoperative pain management is crucial for improving patient outcomes. However, several factors hinder the accurate assessment and management of pain in children, particularly in low-income countries. This study aims to evaluate the severity of postoperative pain in paediatric patients and identify its predictors. Materials and methods A longitudinal study was conducted on 235 paediatric surgical patients aged 2 months-7 years in Public Hospitals of Addis Ababa from January to April 2023. The primary outcome, pain severity, was assessed at three different times using a pain assessment tool. Cochran's q-test was used to compare postoperative pain incidences. The Generalized Estimating Equation was used to determine predictor variables' effects on pain severity over time. The study demonstrated the direction of association and significance using an AOR with a 95% CI at a P value of 0.05. Result The incidence of moderate to severe postoperative pain was 36.6% at 12 h, 20% at 24 h, and 10% at 36 h. Patients with preoperative pain and preoperative anxiety were more likely to experience moderate to severe postoperative pain [adjusted odds ratio (AOR)=3.41, CI=1.15, 10.00 and AOR=2.28, CI=1.219, 4.277, respectively). Intraoperative predictors of postoperative pain severity included longer duration of surgery (AOR=6.62, CI=1.90, 23.00) and major surgery (AOR=5.2, CI=2.11, 12.88). Postoperative pain severity was reduced in patients receiving multimodal analgesia (AOR=0.24; CI=0.091, 0.652) and in patients assessed frequently in the postoperative period (AOR=0.09; CI=0.022, 0.393). Conclusion A significant portion of paediatric surgical patients in this study experienced high levels of postoperative pain, particularly within the first 24 h. The most influential factors affecting pain severity were postoperative pain management strategies and assessment practices.
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Affiliation(s)
- Fassil Mihretu Rede
- Wollo University, College of Medicine and Health Sciences, Department of Anesthesia, Dessie
| | - Eyayalem Melese Goshu
- Addis Ababa University, College of Health Sciences, Department of Anesthesia, Addis Ababa, Ethiopia
| | - Sulaiman Jemal muzien
- Addis Ababa University, College of Health Sciences, Department of Anesthesia, Addis Ababa, Ethiopia
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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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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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Manworren RCB, Kaduwela N, Mishra T, Cooper J. Children's Opioid Use at Home After Laparoscopic Appendectomy. Pain Manag Nurs 2021; 22:708-715. [PMID: 33812791 DOI: 10.1016/j.pmn.2021.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/08/2021] [Accepted: 02/28/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND To combat the opioid epidemic, prescribers need accurate information about pediatric home opioid requirements to manage acute pain after surgery. Current opioid use estimates come from retrospective surveys; this study used medication adherence technology (eCAP) to track home opioid use. PURPOSE To describe children's pain treatment at home after laparoscopic appendectomy, and to compare self-reported opioid analgesic use to eCAP data and counts of returned pills. DESIGN Prospective exploratory and descriptive study METHODS: A convenience sample of 96 patients, 10-17 years of age, from a single urban nonprofit children's hospital consented to self-report pain treatment in 14-day diaries and use eCAP to monitor prescribed opioid use at home after laparoscopic appendectomy. RESULTS Patients were prescribed 5-45 opioid-containing pills (mean ± standard deviation 15 ± 7.2). Of 749 opioid-containing pills prescribed to 49 patients who returned data, 689 pills were dispensed, 167.5 were used for the reason prescribed, 488 were returned to families for disposal, and 53.5 were missing. The majority of the 49 patients were opioid naïve (72%), Caucasian (64%), and male (56%), with a mean age of 14 years. Patients used 6.6 ± 6.3 opioid-containing pills by pill count and 5.6 ± 5.1 by self-report, a significant difference (p = .004). Unreported eCAP-enabled pill bottle openings typically occurred on weekends. CONCLUSION Medication adherence technology (eCAP) is a more rigorous method than self-report to estimate opioid needs and detect early opioid misuse. Additional rigorously designed studies of postoperative opioid use are needed to guide opioid prescribing.
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Affiliation(s)
- Renee C B Manworren
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | | | | | - Jessica Cooper
- KaviGlobal, Barrington, Illinois; University of North Carolina Health, Chapel Hill, North Carolina
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Manworren RCB, Cooper J, Mishra T, Kaduwela N. Children's Pain at Home After Laparoscopic Appendectomy. Pain Manag Nurs 2021; 22:623-630. [PMID: 33744106 DOI: 10.1016/j.pmn.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/02/2021] [Accepted: 02/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Hospitalized children experience moderate-to-severe pain after laparoscopic appendectomy, but knowledge of children's pain experiences after discharge home is limited. Accurate pain assessments are needed to guide appropriate pain treatment. AIMS To describe children's pain at home after laparoscopic appendectomy. DESIGN Prospective exploratory and descriptive METHODS: A convenience sample of 100 patients, aged 10-17 years, who spoke or wrote in English or Spanish, volunteered to complete 14-day pain diaries at home after laparoscopic appendectomy. Visual analytic techniques were used to analyze patterns of pain experiences. RESULTS Diaries were returned by 45 patients/parents, the majority of whom were White (64%), male (56%), adolescents (mean age 14 years) with no previous surgical history (70%), and whose appendix was inflamed (87%) but not perforated. More than 50% reported severe pain (4 or 5 on a 0-5 scale) on the first full day home after laparoscopic appendectomy. On day 7, 40% reported pain and on day 14, 16% were still reporting pain. Only rarely were pain scores not clinically significantly lower 1 hour after pain treatment, regardless of treatment type (e.g., nondrug, nonopioid, opioid). Reported pain intensity steadily decreased over time as did frequency of recorded pain scores. CONCLUSION Adolescents experience severe pain at home after laparoscopic appendectomy and some experience pain for 7 to 14 days after hospital discharge. Visual analytics better represent the dynamics of pain experiences than measures of central tendency.
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Affiliation(s)
- Renee C B Manworren
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago 60611, Illinois; Northwestern University Feinberg School of Medicine, Chicago 60611, Illinois.
| | - Jessica Cooper
- University of North Carolina Health, Chapel Hill, North Carolina
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An Exploration of the Practical and Ethical Issues of Research Using Multi-Visual Methods with Children Affected by Chronic Pain. SOCIETIES 2019. [DOI: 10.3390/soc9040081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper intends to encourage further reflection on the research methods and approaches used to enhance the voices of children with chronic conditions. Visual methods (e.g., ‘draw, write, and tell’ and photo elicitation interviews) have been described as the most appropriate ways to develop research with children as they allow room for children to share their lived experiences in their own terms and to actively participate in the research process, by giving them the opportunity to act as co-researchers. In fact, the use of these methods also contributes to empowering children and mitigating the power differences that exist between the adult researcher and young participants. Drawing on an ongoing study on the experience and management of chronic pain in childhood, this paper provides insights on the usefulness of using these multi-methods to address (potentially) sensitive topics with a (potentially) vulnerable group. The ethical and methodological challenges faced by the researcher when conducting research with ill children in the healthcare context are addressed. The paper looks at the dilemmas of studying chronic pain in childhood and highlights the ways in which multi visual methods can help children in the meaning making of chronic pain.
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Jang JH, Park WH, Kim HI, Chang SO. Ways of Reasoning Used by Nurses in Postoperative Pain Assessment. Pain Manag Nurs 2019; 21:379-385. [PMID: 31672460 DOI: 10.1016/j.pmn.2019.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 04/10/2019] [Accepted: 09/20/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Postoperative pain is a major concern of patients undergoing surgery. Pain assessment for patients undergoing surgery is a common requirement for surgical nurses and is the most important nursing approach to ensuring patient comfort. AIMS The purpose of this study was to identify the reasoning used by nurses when assessing postoperative pain in patients. METHODS Phenomenography was the research approach chosen to analyze the nurses' experiences. This approach is used to acquire qualitative knowledge about the ways individuals experience the world. RESULTS The reasoning used by nurses in postoperative pain assessment was identified from two perspectives: the frames of reference used to interpret a patient's perception of pain and the strategic efforts used to assess the pain. An outcome space for the various categories of reasoning employed by the nurses with regard to postoperative pain assessment was constructed to determine how these categories were logically related. CONCLUSIONS These findings have the potential to lead to a diverse range of nursing education modalities related to the adoption of different focuses and actions in postoperative pain assessment.
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Affiliation(s)
- Jin Hee Jang
- Korea University Anam Hospital, Seoul, Republic of Korea
| | - Won Hee Park
- College of Nursing, Korea University, Seoul, Republic of Korea
| | - Hyo-In Kim
- College of Nursing, Korea University, Seoul, Republic of Korea
| | - Sung Ok Chang
- College of Nursing, Korea University, Seoul, Republic of Korea.
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Nurses’ Knowledge, Attitudes and Clinical Practice in Pediatric Postoperative Pain Management. Pain Manag Nurs 2018; 19:585-598. [DOI: 10.1016/j.pmn.2018.04.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 02/11/2018] [Accepted: 04/01/2018] [Indexed: 11/18/2022]
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Harvey KA, Kovalesky A. Post-Operative Pain and Comfort in Children After Heart Surgery: A Comparison of Nurses and Families Pre-operative Expectations. J Pediatr Nurs 2018; 43:9-15. [PMID: 30473162 DOI: 10.1016/j.pedn.2018.07.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 07/28/2018] [Accepted: 07/30/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE Parents' and nurses' expectations about pain control and comfort in children after heart surgery were explored to contribute to evidence-based family-centered interventions. DESIGN AND METHODS 20 nurses and 23 parents from a tertiary pediatric center in the Pacific Northwest, were interviewed about their expectations of children's pain control and comfort experience in the hospital after heart surgery. In this descriptive study, data were collected from semi-structured recall interviews and analyzed using content analysis. RESULTS Most parents expected their child be medicated at a level of not feeling any pain. Many expected their child to remain in a heavily sedated state after the surgery. A few parents did not know what to expect. In contrast, nurses expected children to have controlled pain with intermittent discomfort, yet, tolerating recovery activities. CONCLUSIONS Although both parents and nurses expect to partner in the comfort care of the child, there is variation on the expectations around the nurse-parent relationship and the operational definition of pain management and comfort. PRACTICE IMPLICATIONS Awareness of parents' expectations about pediatric post-operative comfort present an opportunity for the development of interventions aimed to enhance alignment of nurse and family strategies for children after heart surgery. Pre-operative preparation for families specific to post-operative recovery and pain management of children hospitalized for heart surgery is needed.
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Affiliation(s)
- Kayla A Harvey
- Mary Bridge Children's Hospital, Pediatric Heart Surgery Program, Tacoma, WA, USA.
| | - Andrea Kovalesky
- School of Nursing and Health Studies, University of Washington Bothell, Bothell, WA, USA.
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Affiliation(s)
- David Barrett
- Faculty of Health Sciences, University of Hull, Hull, UK
| | - Alison Twycross
- School of Health and Social Care, London South Bank University, London, UK
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Factors Leading to Persistent Postsurgical Pain in Adolescents Undergoing Spinal Fusion: An Integrative Literature Review. J Pediatr Nurs 2018; 38:74-80. [PMID: 29167085 DOI: 10.1016/j.pedn.2017.10.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 10/21/2017] [Accepted: 10/22/2017] [Indexed: 11/20/2022]
Abstract
PROBLEM Adolescent idiopathic scoliosis (AIS) is the most common spinal deformity among children and adolescents and the most frequent reason for corrective spinal fusion (SF). Of the children and adolescents who undergo SF, a significant number will experience persistent postoperative pain (PPP). This integrative literature review was conducted to identify and synthesize perioperative factors that may contribute to risk of developing PPP. ELIGIBILITY CRITERIA Articles which addressed PPP within the last 10years and primary research on postoperative pain outcomes in adolescents after SF were selected for review. SAMPLE 15 articles which met eligibility criteria were included. RESULTS Preoperative pain intensity was the most significant factor identified in the development of PPP and increased postoperative pain. Social function and psychological factors also have role in the development of PPP. There were no theoretical models or frameworks for evaluating PPP incidence in adolescent with AIS after SF. CONCLUSIONS Perioperative factors such as, preoperative pain, correction magnitude, pain coping, anxiety and social functioning are vital to understanding a child's risk of PPP following SF. There is a need for theoretically-based studies to assess PPP among children and adolescents with AIS after SF surgery. IMPLICATIONS The Biobehavioral Pain Network (BPN) model was proposed, to encompass biological, social and psychological domains which may be responsible for incidence of PPP in children undergoing SF. Such a model can be used to systematically develop and evaluate personalized postoperative pain management strategies for this patient population.
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