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Achaliwie F, Wakefield AB, Mackintosh-Franklin C. The impact of education on the knowledge and attitudes of Ghanaian nurse tutors towards the assessment and management of pain in children: A quantitative study. NURSE EDUCATION TODAY 2023; 121:105680. [PMID: 36495595 DOI: 10.1016/j.nedt.2022.105680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/19/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Undertreatment of pain in children is an international problem as many children reports unresolved moderate to severe pain. One key factor which may contribute to under treatment of pain in children by nurses is lack of knowledge. In Ghana opportunities for nurses to learn about pediatric pain have been limited due to gaps in the undergraduate curriculum and inadequate continuing professional education post qualification. OBJECTIVE To assess tutors' knowledge and attitudes to pediatric pain management before and after an educational workshop. DESIGN Single group pre-test-post-test design. SETTING One Ghanaian Nursing Training College. PARTICIPANTS All (37) nursing tutors in the college. METHOD Total population sampling was used to access 37 tutors, data were collected using the Knowledge and Attitude Survey Regarding Pain at 3 stages; pre-intervention, immediately after the train-the-trainer based Pediatric Pain Educational Workshop and at 3-months follow-up. Data from the survey were analyzed using descriptive and inferential statistics. RESULTS Results at pre-intervention showed low scores in the survey. However, post-intervention results at both the immediate and 3-months follow-up stages revealed a significant increase from pre-intervention: Mean (SD) of 20.35 (4.56), to immediate follow-up Mean (SD) 26.93 (5.02), and 3-months follow-up Mean (SD) 25.19 (5.80) and a p-value of <0.001. CONCLUSION The results suggest tutors' knowledge and attitudes regarding pediatric pain management can be directly improved through a nurse tutor focused educational program. However, knowledge declines with time and as such there is the need for regular update through Continuing Professional Development activities.
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Affiliation(s)
- Francisca Achaliwie
- Department of Nursing, School of Nursing and Midwifery, CK Tedam University of Technology and Applied Sciences, P. O. Box 24, Navrongo, Ghana.
| | - Ann B Wakefield
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Carolyn Mackintosh-Franklin
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester M13 9PL, UK
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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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Matula ST, Irving SY, Deatrick JA, Steenhoff AP, Polomano RC. The Prevalence, Intensity, Assessment, and Management of Acute Pain in Hospitalized Children in Botswana. Pain Manag Nurs 2022; 23:548-558. [PMID: 34987004 DOI: 10.1016/j.pmn.2021.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 11/28/2021] [Accepted: 11/30/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND There is very limited clinical and observational data on acute pain experienced by children in sub-Saharan Africa. AIMS To report the prevalence and intensity of acute pain, pain management practices, and describe associations between acute pain outcomes, children's and parents or guardian's demographics in hospitalized children aged 2 months to 13 years in Botswana. DESIGN A descriptive correlational prospective observational study using five repeated cross-sectional samples. SETTINGS Two referral hospitals in Botswana. PARTICIPANTS The sample size included 308 children and 226 parents or guardians. Data were collected between November 2018 and February 2019 from children, their parents or guardians (<7 years child), and the health record for pain documentation and treatment. MEASURES Pain was measured using Faces Pain Scale-Revised for children ≥7 years, revised Face, Legs, Activity, Cry, Consolability scale for children <7 years and numeric rating scale for parents or guardians. RESULTS There are 1,290 data points for children of which 1,000 were children <7 years and 999 data points for parents or guardians of children <7 years were used in analysis. Fifty percent of children <7 years were in pain using the revised Face, Legs, Activity, Cry, Consolability scale, whereas parents indicated 46% to be in pain. The pain prevalence for children ≥7 years was estimated at 54%. Pain was documentated at a rate of 54 % on the health records. Acetaminophen was most common analgesic across all age groups. Univariate associations of child <7 years pain intensity was statistically significant (p ≤ .05) for weight, diagnosis, residence, and parent relationship. Parents reported pain intensity was statistically significant (p ≤ .05) for child sex, weight, diagnosis, residence, surgery, parent or guardian age and education. Only age and surgery were significant for children ≥7 years. CONCLUSIONS Acute pain prevalence and intensity among hospitalized children in Botswana is low.
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Affiliation(s)
- Samuel T Matula
- Faculty of Health Sciences, School of Nursing, University of Botswana, Gaborone, Botswana.
| | - Sharon Y Irving
- Division of Anesthesiology and Critical Care Medicine/Critical Care Nursing, University of Pennsylvania, Nurse Practitioner, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Andrew P Steenhoff
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Global Health Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Paediatric and Adolescent Health, Faculty of Medicine, University of Botswana
| | - Rosemary C Polomano
- University of Pennsylvania, Philadelphia, Pennsylvania; School of Nursing, Professor of Anesthesiology and Critical Care, Perelman School of Medicine, Philadelphia, Pennsylvania
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Kusi Amponsah A, Oduro E, Bam V, Kyei-Dompim J, Ahoto CK, Axelin A. Dynamics on the field: a focused study on the culture and context of pediatric pain management at four Ghanaian hospitals. BMC Pediatr 2020; 20:529. [PMID: 33218327 PMCID: PMC7678185 DOI: 10.1186/s12887-020-02399-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background As part of efforts to develop and implement a short course educational program on pediatric pain management, the current study sought to understand the culture and contextual factors that influence children’s pain management in order to improve the practice in pediatric care settings. Methods Guided by Bourdieu’s theory of practice, a focused ethnographic study was conducted from October, 2018 to February, 2019. The study was contextualized at four Ghanaian hospitals among purposefully sampled nurses, physicians, hospitalized children and their families. During the 20-week study period, three ethnographers spent 144 h conducting participant-observation sessions. Formal and informal interviews were held with participants in addition to review of hospital records. Results Analysis of the field data resulted in four themes. “Children’s pain expression and response of caregivers” described the disposition (habitus) of both children and caregivers to act in particular ways due to children’s incomplete health status (bodily capital) which caused them pain and also resulted in discomforting procedures. “Pharmacological pain management practices and attitudes” elucidated the use of analgesics as the mainstay disposition (habitus) in children’s pain management due to high level of respect (symbolic capital) given to such interventions on the pediatric units (field). “Managing pain without drugs” illustrated healthcare providers and family caregivers’ disposition (habitus) of using diverse nonpharmacological methods in managing children’s pain. “Communication and interaction between pain actors” depicted how children’s access to care givers (social capital) can serve as a powerful tool in influencing pediatric pain assessment and management disposition (habitus) on the pediatric units (field). Conclusions The habitus of pediatric pain actors toward pain assessment and management practices are influenced by various forms of capital (social, cultural, symbolic, bodily and economic) operating at different levels on the pediatric care field. Quality improvement programs that seek to enhance pediatric pain management should use the insights obtained in this study to guide the development, implementation and evaluation stages. Supplementary Information Supplementary information accompanies this paper at 10.1186/s12887-020-02399-w.
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Affiliation(s)
- Abigail Kusi Amponsah
- Department of Nursing Sciences, Faculty of Medicine, University of Turku, Turku, Finland. .,Department of Nursing, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Evans Oduro
- Department of Nursing, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Victoria Bam
- Department of Nursing, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Joana Kyei-Dompim
- Department of Nursing, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Collins Kwadwo Ahoto
- Department of Nursing, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Anna Axelin
- Department of Nursing Sciences, Faculty of Medicine, University of Turku, Turku, Finland
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The Effect of Educational Strategies Targeted for Nurses on Pain Assessment and Management in Children: An Integrative Review. Pain Manag Nurs 2019; 20:604-613. [DOI: 10.1016/j.pmn.2019.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 01/22/2019] [Accepted: 03/31/2019] [Indexed: 12/19/2022]
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Kyololo OM, Stevens BJ, Songok J. Mothers' Perceptions about Pain in Hospitalized Newborn Infants in Kenya. J Pediatr Nurs 2019; 47:51-57. [PMID: 31039509 DOI: 10.1016/j.pedn.2019.04.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/13/2019] [Accepted: 04/13/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Explore views of mothers about pain and pain treatment practices in hospitalized newborn infants. DESIGN AND METHODS A Qualitative descriptive study using photo-elicitation technique was conducted in a level I and a level II neonatal units in Kenya. Fifteen semi-structured interviews were conducted with mothers of hospitalized infants. The interviews were audio-recorded, transcribed verbatim and analysed using inductive content analysis approach. RESULTS Mothers described the experience of witnessing their infants undergo painful procedures as emotionally and psychologically traumatic. Participants felt helpless for not being able to protect their infants from pain a situation which was made worse by health care providers who appeared less concerned about pain relief during procedures. Mothers' views demonstrated a good understanding of pain-relief strategies; they identified strategies that health care providers should routinely use to relief pain in hospitalized infants. Furthermore, participants desired to be involved in comforting their infants during clinical procedures. CONCLUSION Repeated and untreated painful procedures continue to define the hospitalisation experience of newborn infants despite the presence of mothers who desire to be involved in comforting their infants during procedures. PRACTICE IMPLICATION Minimizing the burden of pain and using pain-relieving interventions could reduce parental stress and optimize parental role attainment following hospitalisation.
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Affiliation(s)
| | - Bonnie J Stevens
- University of Toronto, Toronto, Canada; The Hospital for Sick Children, Toronto, Canada
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Palliative Care in Botswana: Progress and Challenges. J Hosp Palliat Nurs 2019; 21:E7-E12. [PMID: 31045995 DOI: 10.1097/njh.0000000000000517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Palliative care is an essential aspect of care for patients with serious illness and their families, but a large proportion of the world's population, particularly in developing countries like Botswana, do not have access to it. In Botswana and other developing countries, palliative care is often sporadic and lacks comprehensive delivery owing to a lag between policies and practice and a lack of knowledge about palliative care among health care professionals and communities. In this article, the progress of palliative care in Botswana is discussed by first evaluating at the relevance of palliative care in Botswana given the burden of diseases and resources available for disease management. Second, the palliative care delivery models and their successes and shortcomings in Botswana context are discussed. Third, the Botswana palliative care services are viewed on a global scale to illuminate progress and areas that need improvement. Thereafter, using a case as a reference, this article highlights the challenges faced by Botswana palliative care services. Finally, some areas that can be targeted to improve palliative care services in Botswana and possible solutions are discussed. Overall, palliative care is at infancy stage in Botswana and many opportunities exist in education, research, and resource support to transform it into a full-fledged service.
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Matula ST, Polomano RC, Irving SY. The state of the science in paediatric pain management practices in low-middle income countries: An integrative review. Int J Nurs Pract 2018; 24:e12695. [PMID: 30251308 DOI: 10.1111/ijn.12695] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 06/30/2018] [Indexed: 12/31/2022]
Abstract
AIM Examine the state of the science for pain management in children living in low-middle income countries (LMIC). BACKGROUND Significant challenges exist in pain management for children living in LMIC. METHODS An integrative review was conducted using PRISMA guidelines for quality of reporting. Literature searches were completed using Medline, PubMed, Scopus, and CINAHL databases for publications between January 2006 and August 2016 using MeSH and primary search terms pain and LMIC. Full text publications were evaluated using GRADE criterion and methodology specific evaluation tools. RESULTS Of 1510 publications identified, 31 met the criteria for inclusion. Data were categorized into three broad themes: (1) magnitude of the pain problem with subthemes describing the burden of and resources for paediatric pain management; (2) perceptions, experience, and practices for managing pain in children residing in LMIC with subthemes addressing health care providers, parent/caregiver and children, respectively; and (3) pain management practices with pain assessment and treatment strategies as subthemes. CONCLUSION Current data on paediatric pain management in LMIC are limited with respect to describing the burden of pain, children's pain perceptions and experiences, and pain management practices. Rigorous investigations are needed to expand knowledge and address the pervasive problem of pain for children in LMIC.
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Affiliation(s)
- Samuel T Matula
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Rosemary C Polomano
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA.,University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Sharon Y Irving
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA.,Division of Anesthesiology and Critical Care Medicine/Critical Care Nursing, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Young JR, Sih C, Hogg MM, Anderson-Montoya BL, Fasano HT. Qualitative Assessment of Face Validity and Cross-Cultural Acceptability of the Faces Pain Scale: "Revised" in Cameroon. QUALITATIVE HEALTH RESEARCH 2018; 28:832-843. [PMID: 29571279 DOI: 10.1177/1049732318757488] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The Faces Pain Scale-Revised (FPS-R) is a self-report pain scale validated in numerous countries, but not in Cameroon. We postulated that while cultural factors influence pain perception and expression, the FPS-R should remain culturally acceptable for pediatric use. A convenience sample of 36 pediatric patients, aged 4 to 16 years, representing three primary language groups, was enrolled at Mbingo Baptist Hospital (MBH). Pre- and postanalgesia FPS-R scores and vital signs were obtained. Audio-recorded cognitive interviews were performed with each participant. Written questionnaires were also provided to physicians, nurses, and caretakers to further explore cultural perceptions of pain. Four independent reviewers analyzed interview transcripts and questionnaires using inductive reasoning and identified common themes pertaining to gender differences, societal roles, and pain perception. Basic comprehension of the FPS-R was present across language groups, vital sign changes corresponded with FPS-R alterations, and the FPS-R appears intuitive for pediatric use.
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Affiliation(s)
- James R Young
- 1 Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Colette Sih
- 2 Mbingo Baptist Hospital, Cameroon, West Africa
| | - Melanie M Hogg
- 1 Carolinas Medical Center, Charlotte, North Carolina, USA
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