Downloaded from http://ebn.bmj.com/ on March 10, 2015 - Published by group.bmj.com
Child health Qualitative study—other
Children’s experience of postoperative pain relief: children, parents and nurses use various pharmacological and non-pharmacological approaches, particularly distraction
analgesics with opioids such as oxycodone and morphine infusions used less frequently. In addition, to the administration of analgesics the children used a variety of strategies to cope with their postoperative pain including cognitive–behavioural methods, physical methods and seeking help. Five themes emerged from the analysis of the interview data; ‘children’s self-directed actions to relieve pain postoperatively’, ‘children’s perceptions of actions parents take for their postoperative pain relief’, ‘children’s perceptions of actions nurses take for their postoperative pain relief’, ‘suggestions for parents for alleviating postoperative pain’ and ‘suggestions for nurses to alleviate postoperative pain’.
10.1136/eb-2013-101417
Commentary Joan Simons Faculty of Health Buckinghamshire, UK
and
Social
Care,
The
Open
University,
Correspondence to: Dr Joan Simons, Faculty of Health and Social Care, The Open University, Walton Hall, Milton Keynes, Buckinghamshire MK7 6AA, UK; [email protected]
Commentary on: Sng QW, Taylor B, Liam JL, et al. Postoperative pain management experiences among school-aged children: a qualitative study. J Clin Nurs 2013;22:958–68.
Implications for practice and research ▪ Healthcare professionals need to value the role children can play in the management of their pain. ▪ Involving parents in the assessment of a child’s pain will help identify when a child appears to be concealing their pain. ▪ In order for pain management in children to improve, there needs to be commitment at ward and organisational level.
Context Children are dependent on parents and nurses to help them cope with their pain following surgery. However, school-aged children are able to evaluate how their pain is managed and what strategies they prefer. Although pain medication is the cornerstone of pain management, there is increasing recognition of the value of non-pharmacological pain relieving methods. In addition, parental presence is a valuable source of emotional support.
This is an important study because pain management in children remains a somewhat overlooked area. The children reported that they play an active part in trying to deal with their pain postoperatively. They also articulated the active involvement of parents in dealing with their pain. An interesting finding relates to children’s perceptions of nurses’ roles, in particular they did not appear to recognise that nurses assessed their pain, yet the study reports pain scores ranged from 2 to 10. Assessing pain is the cornerstone of pain management and this finding warranted further exploration by the authors. It is likely that the children were asked their pain score using the numeric scale but did not recognise this was part of the nurses assessing their pain or it may have been that nurse recorded their own subjective ‘score’ without involving children based on the child’s behaviours.1 Although asking the children to selfreport their pain,2 is the gold standard in pain assessment, previous research has reported nurses often base the assessment on their own judgement of the child’s pain.3 The study has a number of limitations; first, although the sample strategy aimed to recruit children aged from 6 to 12- years-old, all participants were 8 years of age or older. Second, the interviews were described as ‘in-depth’; however, they were reported as lasting ‘approximately 10 min’, which may have impacted the depth of data collected. The children made two suggestions; first, the importance of parental presence; and second, nurses could be more active in helping them to adopt more comfortable positions. These suggestions at face value seem manageable and within the remit of parents and nurses. However, encouraging parents to be present with their hospitalised child more than current practice is complex and multi-faceted and in part depends on how welcome parents are made on the children’s unit and how nurses facilitate them to become involved in their child’s care. In relation to nurses positioning the children for comfort, nurses may have to change their practices and engage more effectively with children as individuals to be able to recognise and meet their needs to find a comfortable position. Such a change could require a change in nurses’ attitudes in relation to parents’ role as well as to managing children’s pain.
Methods Sng and colleagues undertook a qualitative study to explore children’s views of their postoperative pain experiences. Purposive sampling resulted in the recruitment of 15 children, aged 6–12 years, over a 2-month period from two wards in a Singapore hospital. The children had all undergone surgery (including orchidopexy, laparoscopic appendectomy and squint correction), had a minimum postoperative stay of 24h and could communicate in either English or Mandarin. In-depth, semistructured interviews were undertaken with the children. Each interview lasted about 10 min. All interviews were recorded and transcribed by the same researcher. Data gathering continued until saturation was achieved.
Findings Pain scores ranged from 2 to 10 on the numeric pain rating scale. Paracetamol and ibuprofen were the most commonly administer
88
Evid Based Nurs July 2014 | volume 17 | number 3 |
Competing interests None.
References 1. Merkel SI, Voepel-Lewis T, Shayevitz JR, et al. The FLACC: a behavioural scale for scoring postoperative pain in young children. Pediatr Nurs 1997;23:293–7. 2. APA: Association of Paediatric Anaesthetists. Good practice in postoperative and procedural pain. London: APA, 2012. 3. Simons J, MacDonald LM. Changing practice: implementing validated paediatric pain assessment tools. J Child Health Care 2006;10:160–76.
Downloaded from http://ebn.bmj.com/ on March 10, 2015 - Published by group.bmj.com
Children's experience of postoperative pain relief: children, parents and nurses use various pharmacological and non-pharmacological approaches, particularly distraction Joan Simons Evid Based Nurs 2014 17: 88 originally published online October 17, 2013
doi: 10.1136/eb-2013-101417 Updated information and services can be found at: http://ebn.bmj.com/content/17/3/88
These include:
References Email alerting service
Topic Collections
This article cites 3 articles, 1 of which you can access for free at: http://ebn.bmj.com/content/17/3/88#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Articles on similar topics can be found in the following collections Pain (neurology) (295) Child health (53) Pain (anaesthesia) (65) Pain (palliative care) (76) Hospice (104) Child health (437) Drugs: musculoskeletal and joint diseases (149) Gastrointestinal surgery (25)
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
Child health Qualitative study—other
Children’s experience of postoperative pain relief: children, parents and nurses use various pharmacological and non-pharmacological approaches, particularly distraction
analgesics with opioids such as oxycodone and morphine infusions used less frequently. In addition, to the administration of analgesics the children used a variety of strategies to cope with their postoperative pain including cognitive–behavioural methods, physical methods and seeking help. Five themes emerged from the analysis of the interview data; ‘children’s self-directed actions to relieve pain postoperatively’, ‘children’s perceptions of actions parents take for their postoperative pain relief’, ‘children’s perceptions of actions nurses take for their postoperative pain relief’, ‘suggestions for parents for alleviating postoperative pain’ and ‘suggestions for nurses to alleviate postoperative pain’.
10.1136/eb-2013-101417
Commentary Joan Simons Faculty of Health Buckinghamshire, UK
and
Social
Care,
The
Open
University,
Correspondence to: Dr Joan Simons, Faculty of Health and Social Care, The Open University, Walton Hall, Milton Keynes, Buckinghamshire MK7 6AA, UK; [email protected]
Commentary on: Sng QW, Taylor B, Liam JL, et al. Postoperative pain management experiences among school-aged children: a qualitative study. J Clin Nurs 2013;22:958–68.
Implications for practice and research ▪ Healthcare professionals need to value the role children can play in the management of their pain. ▪ Involving parents in the assessment of a child’s pain will help identify when a child appears to be concealing their pain. ▪ In order for pain management in children to improve, there needs to be commitment at ward and organisational level.
Context Children are dependent on parents and nurses to help them cope with their pain following surgery. However, school-aged children are able to evaluate how their pain is managed and what strategies they prefer. Although pain medication is the cornerstone of pain management, there is increasing recognition of the value of non-pharmacological pain relieving methods. In addition, parental presence is a valuable source of emotional support.
This is an important study because pain management in children remains a somewhat overlooked area. The children reported that they play an active part in trying to deal with their pain postoperatively. They also articulated the active involvement of parents in dealing with their pain. An interesting finding relates to children’s perceptions of nurses’ roles, in particular they did not appear to recognise that nurses assessed their pain, yet the study reports pain scores ranged from 2 to 10. Assessing pain is the cornerstone of pain management and this finding warranted further exploration by the authors. It is likely that the children were asked their pain score using the numeric scale but did not recognise this was part of the nurses assessing their pain or it may have been that nurse recorded their own subjective ‘score’ without involving children based on the child’s behaviours.1 Although asking the children to selfreport their pain,2 is the gold standard in pain assessment, previous research has reported nurses often base the assessment on their own judgement of the child’s pain.3 The study has a number of limitations; first, although the sample strategy aimed to recruit children aged from 6 to 12- years-old, all participants were 8 years of age or older. Second, the interviews were described as ‘in-depth’; however, they were reported as lasting ‘approximately 10 min’, which may have impacted the depth of data collected. The children made two suggestions; first, the importance of parental presence; and second, nurses could be more active in helping them to adopt more comfortable positions. These suggestions at face value seem manageable and within the remit of parents and nurses. However, encouraging parents to be present with their hospitalised child more than current practice is complex and multi-faceted and in part depends on how welcome parents are made on the children’s unit and how nurses facilitate them to become involved in their child’s care. In relation to nurses positioning the children for comfort, nurses may have to change their practices and engage more effectively with children as individuals to be able to recognise and meet their needs to find a comfortable position. Such a change could require a change in nurses’ attitudes in relation to parents’ role as well as to managing children’s pain.
Methods Sng and colleagues undertook a qualitative study to explore children’s views of their postoperative pain experiences. Purposive sampling resulted in the recruitment of 15 children, aged 6–12 years, over a 2-month period from two wards in a Singapore hospital. The children had all undergone surgery (including orchidopexy, laparoscopic appendectomy and squint correction), had a minimum postoperative stay of 24h and could communicate in either English or Mandarin. In-depth, semistructured interviews were undertaken with the children. Each interview lasted about 10 min. All interviews were recorded and transcribed by the same researcher. Data gathering continued until saturation was achieved.
Findings Pain scores ranged from 2 to 10 on the numeric pain rating scale. Paracetamol and ibuprofen were the most commonly administer
88
Evid Based Nurs July 2014 | volume 17 | number 3 |
Competing interests None.
References 1. Merkel SI, Voepel-Lewis T, Shayevitz JR, et al. The FLACC: a behavioural scale for scoring postoperative pain in young children. Pediatr Nurs 1997;23:293–7. 2. APA: Association of Paediatric Anaesthetists. Good practice in postoperative and procedural pain. London: APA, 2012. 3. Simons J, MacDonald LM. Changing practice: implementing validated paediatric pain assessment tools. J Child Health Care 2006;10:160–76.
Downloaded from http://ebn.bmj.com/ on March 10, 2015 - Published by group.bmj.com
Children's experience of postoperative pain relief: children, parents and nurses use various pharmacological and non-pharmacological approaches, particularly distraction Joan Simons Evid Based Nurs 2014 17: 88 originally published online October 17, 2013
doi: 10.1136/eb-2013-101417 Updated information and services can be found at: http://ebn.bmj.com/content/17/3/88
These include:
References Email alerting service
Topic Collections
This article cites 3 articles, 1 of which you can access for free at: http://ebn.bmj.com/content/17/3/88#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Articles on similar topics can be found in the following collections Pain (neurology) (295) Child health (53) Pain (anaesthesia) (65) Pain (palliative care) (76) Hospice (104) Child health (437) Drugs: musculoskeletal and joint diseases (149) Gastrointestinal surgery (25)
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
