Nurses' perceptions of parental guidance in pediatric surgical pain relief

The aim of this study was to describe nurses' perceptions of how they guide parents in the relief of their child's (aged 8-12 years) surgical pain in the hospital, and factors related to this function. The convenience sample consisted of 162 nurses working on the pediatric surgical wards of five university hospitals in Finland. The data was collected with a Likert-type instrument designed for this purpose. The results of this study indicated that nurses felt parents were mostly well informed about their child's surgical procedure, including both cognitive and sensory information, and about the non-pharmacological methods employable for relieving their child's pain. However, some deficiency was identified in the preparatory information, as well as in the cognitive-behavioral and physical methods. Factors related to the nurses' background, such as age, education, work experience and the nurse's own experiences with prior hospitalizations of their children, appeared to have some effects on their perceptions regarding parental guidance.     

Strategies for feeling secure influence parents' participation in care

This study investigates what makes parents of hospitalized children feel secure and factors influencing their level of participation. It also studies, whether the degree to which parents participate affects their child's pain and sleep during hospitalization. Questionnaires were distributed to a series of parents whose children were discharged from two paediatric surgical wards and one paediatric medical-surgical ward at two university hospitals in Sweden. Parental security is almost equally distributed among three given alternatives: security derived from trusting that professionals know how to take care of the child; security derived from having control over what is happening to the child; and security derived from being the one who knows the child best. Depending upon the strategy chosen, parents want to participate at different levels in their child's care. The results indicate a relationship between parental participation and their estimation of their child's pain. The study confirms a pattern, developed in a previous study, in how parents adopt different strategies affecting their participation during their child's hospitalization. Some parents who wanted to participate in more aspects of their child's care seemed to think that their child had less pain than parents who preferred more limited participation.     

Parental views on participation in their child's pain relief measures and recommendations to health care providers

The purpose of this study was to describe parental views on the factors influencing participation in their 8- to 12-year-old hospitalized child's surgical pain relief measures, and the recommendations to health care providers concerning alleviation of their child's pain. The data were collected by a questionnaire completed by parents (N = 192) whose child was hospitalized in one of the pediatric surgical wards in the five university hospitals of Finland. Results revealed that most of the parents (98%) agreed to having adequate opportunities to participate in their child's care according to their personal preferences; however, only 23% of the parents totally agreed that they had a clearly defined role in their child's pain relief measures. Feelings such as concern, fear, helplessness, anxiety, and depression were commonly experienced by the parents during their child's hospitalization. Most of the parents' recommendations concerned the topic of providing information. The findings of this study have implications for nursing practice.     

Concepts of pain in preschoolers and children of early school age and their parents after painful interventions during hospitalization

Subject of the present study are individual pain concepts of preschoolers and children of early school age. Their parents' concepts of pain were considered as well. In a qualitative study interviews were performed with 9 children and their parents in a children's hospital to investigate their individual concepts of pain, their methods of pain assessment, and self-initiated strategies of pain alleviation. Already 4-6 year old children are able to remember painful experiences and to communicate about pain. Strategies of pain alleviation used by children are distraction methods as well as methods of physical relief. The child's parents play an important role concerning pain assessment and coping. The parents' presence is also very important to communicate the child's needs to nurses. Parents want nurses to consider physiological as well as behavioral aspects in the assessment of the child's pain. Besides, they expect nurses to have competences concerning prevention, assessment and alleviation of pain. To perform a trustful relationship to children and parents, more intensified counselling by nurses seems necessary.     

学龄儿童急诊术后家长止痛护理参与的调查与分析

目的 了解家长对学龄患儿急诊术后止痛方法的了解程度和对止痛护理的参与程度,研究其相关影响因素,以指导学龄儿童急诊术后疼痛的护理工作.方法 采用自行设计的问卷,对100名急诊术后学龄患儿的家长进行调查.结果 除止痛药物之外,家长常用的止痛方法有安慰鼓励、创造舒适环境、物质奖励和改变体位等.家长的年龄、受教育程度、有无陪伴子女住院经历等因素与止痛方法的使用存在显著相关,而对其他止痛知识的匮乏和缺乏护理人员的指导帮助则限制了家长对儿童急诊术后止痛护理的参与.结论 护理人员应重视患儿的急诊术后止痛护理,向家长传授更多的止痛知识和方法,提高其对减轻儿童术后疼痛重要性和必要性的认识,并积极配合家长使用多种方法减轻学龄儿童急诊术后疼痛.     

Parents' support and satisfaction with their child's postoperative care

It is recognized that parents' presence during their child's hospitalization is of benefit to the parents and the child. However, the level of parental involvement in their child's care may be influenced by many factors, such as the amount of support nurses provide for parents. This article reports on two themes from the findings of a larger study on parental involvement in children's postoperative pain management - parental support and parents' satisfaction with their child's postoperative pain management. The aim of the larger study was to explore both nurses' and parents' perceptions of parental involvement in their child's postoperative pain management. The methods used were both qualitative and quantitative. The qualitative method of phenomenology was used to guide 20 nurse and 20 parent interviews. Quantitative methods involved surveying the nurses and parents on their perceptions of how supportive the nurses were towards the parents. The charts of 20 children were reviewed for pain-related data. This article reports on the issues of parent support from the results of the survey, and on satisfaction relating to their child's postoperative pain management from the parent interviews. The findings demonstrated that nurses perceived that parents were receiving more support from them than that which parents felt they were receiving. Parents were more satisfied with their child's pain management and children received more analgesia when they were cared for by a lower grade nurse.     

Caring for adoptive families: lessons in communication

PURPOSE: To describe the experiences of families whose adopted children were hospitalized and to compare those experiences to the experiences of families of hospitalized biological children. METHOD: The parents of 10 adopted and 55 biological children participated in the study in which the source and intensity of stress for parents and the level of distress demonstrated by the children during their hospitalization were measured and compared. RESULTS: Adopted children hospitalized for the first time were significantly more distressed during hospitalization than biological children hospitalized for the first time. Adoptive parents experienced significantly more stress than biological parents related to how staff communicated with them about their child's illness. Concerns identified by several adoptive families included difficulties associated with having limited information about their child's family medical history and concerns about attachment issues. CONCLUSIONS: Health care providers need to be aware of adoptive parents' concerns about their child's response to hospitalization, attachment issues, and limited family medical history. The quality of communication with adoptive parents is especially important.     

Factors influencing nurses' use of nonpharmacological pain alleviation methods in paediatric patients

The purpose of this study was to describe the factors promoting and hindering nurses' use of nonpharmacological methods in children's surgical pain relief, and demographic variables related to this. The data were collected by a Likert-type questionnaire, which was completed by nurses (n = 162) who were working in one of the paediatric surgical wards located in university hospitals in Finland. The response rate was 99%. Factor analysis was used to analyse the data. According to the results, five promoting factors (nurse's competence, versatile use of pain alleviation methods, workload/time, child's age/ability to cooperate, and parental participation), as well as five hindering factors (nurse's insecurity, beliefs regarding parental roles/child's ability to express pain, heavy workload/lack of time, limited use of pain alleviation methods, and work organizational model/patient turnover rate) were found to influence the nurses' use of nonpharmacological methods. Almost all of the nurses (98%) hoped to make progress in their career and to learn different pain alleviation methods, but less than half of them (47%) agreed that they had obtained sufficient education regarding these methods. Demographic variables such as the nurse's age, education, and work experience were significantly related to certain factors influencing the use of nonpharmacological methods. In conclusion, paediatric patients' surgical pain relief in the hospital was affected more by the nurses' personal characteristics, than by work-related factors or characteristics of the child or the child's parents. The nurses had positive attitudes towards learning different pain alleviation methods, which constitute the basis for the development of pain management in paediatric patients.     

护士指导患儿父母使用减轻术后疼痛方法的研究

目的:了解护士给予患儿父母有关非药物方法减轻儿童(6～12岁)术后疼痛的指导情况。方法:采用芬兰Tarja Plkki博士设计的问卷对福建省5所医院178名护士进行调查。结果:被指导最多的非药物方法有转移注意力、积极性强化、安慰、改变体位以及放松。护士的年龄、教育程度、职称、护理经验、有无孩子及陪伴孩子住院经历、所在医院和科室,皆与其指导父母使用某些药物方法存在显著相关。结论:护士虽给予父母亲多方缓解儿童术后疼痛的指导,某些薄弱环节尚需加强。     

Chinese parent's use of nonpharmacological methods in children's postoperative pain relief

Parental participation in paediatric postoperative care is common in China. However, the knowledge is limited on what methods parents use to relieve their children's postoperative pain in hospital. The purpose of this study was to describe what nonpharmacological methods parents use to relieve their children's postoperative pain and factors related to this. A previously validated Scandinavian questionnaire survey was conducted in five provincial hospitals in Fujian, China, in 2004. Parents (n = 206) whose children had undergone operation were asked to complete questionnaires concerning nonpharmacological methods for children's pain relief. The response rate was 88%. Results show that the most commonly used methods by parents were emotional support strategies, helping with daily activities, distraction and imagery. Breathing technique was the method used least frequently. Fathers and parents who were older, more educated, employed and with earlier hospitalization experience with their children used pain alleviation methods more frequently than mothers and parents without these characteristics. Moreover, parents used some methods more frequently with boys, younger children, as well as children admitted for selective operations, with longer duration of hospitalization and with moderate or severe pain. Parents utilized various nonpharmacological methods for children's pain relief, especially those easy to use. This study may serve to focus healthcare providers' efforts on educating parents with respect to various nonpharmacological pain alleviation methods available for postoperative pain. Furthermore, this study provides parents an opportunity to be aware of their role in their children's pain management.     

Parents' use of nonpharmacological methods to alleviate children's postoperative pain at home

STUDY BACKGROUND: Nonpharmacological methods are stated to be effective in alleviating children's postoperative pain when used as an adjuvant to analgesics. However, little is known about how these methods are used by parents at home. PURPOSE OF THE STUDY: The purpose of this study was to describe parents' use of nonpharmacological methods at home in 1-6-year-old children's pain alleviation after minor day surgery. METHODS: Mothers (n = 201) and fathers (n = 114) whose child had undergone day surgery in 10 Finnish hospitals between October 2000 and September 2001 filled in a questionnaire including a Visual Analogue Scale, Parents' Postoperative Pain Measure and a subscale consisting of 25 items measuring parents' use of several nonpharmacological pain alleviation methods with their children at home after day surgery. RESULTS: The most frequently used nonpharmacological pain alleviation methods were holding the child on the parent's lap, comforting the child and spending more time with them. Differences were found in mothers' and fathers' use of these methods. In addition, several methods were used more with girls than with boys. Significant relationships were found between parents' use of nonpharmacological pain alleviation methods and children's pain intensity and pain behaviour. CONCLUSIONS: Parents used several nonpharmacological pain alleviation methods with their children. However, their implementation seemed to be gender-related and limited to methods that were familiar to the parents from everyday life. The findings can be used in advising parents to use nonpharmacological pain alleviation methods at home after surgical procedures. Further research using experimental designs is needed into the effectiveness of these methods.     

Optimism, anxiety, and coping in parents of children hospitalized for spinal surgery

Optimistic expectations about outcomes have significant implications for behaviors. Knowing the role that dispositional optimism plays in parents' anxiety and coping responses during their child's surgical experience is essential to aid professionals in bolstering parents' coping and providing support. Parental optimism, anxiety and coping, and whether optimism moderated (changed) the anxiety-coping relationship preoperatively and postoperatively were the factors evaluated in this study. Parents (N = 60) primarily white of middle and upper middle class, were administered the Life Orientation Test to assess optimism, Spielberger's State Anxiety Scale and the Ways of Coping Questionnaire. Parental anxiety decreased significantly from preoperative to postoperative levels but remained high, indicating that parents continue to be emotionally distressed during their child's recovery. Reappraising the situation more positively (positive reappraisal) was the most often used emotion-focused coping strategy and seeking social support was the most often used problem-focused coping strategy. The preoperative and postoperative anxiety-coping relationships also depended on parents' levels of optimism. The use of emotion-focused coping strategies was not effective for reducing anxiety in highly optimistic parents. Recommendations include continually assessing the parents' need for reassurance and support throughout the surgical experience. Professionals can bolster parental coping by stressing the benefits of surgery and encouraging parents to be actively involved in the child's care and progress.     

The experience of stress in parents of children hospitalized with long-term disabilities

This paper discusses parents' perceptions of their stress when their children are hospitalized with long-term disabilities. The study used a qualitative method. Data were collected with 40 parents through in-hospital interviews, and were analysed using the method of constant, comparative analysis. Parents' own interpretation of their stress experience is considered in relation to their perception of their role. The data suggest that the hospitalization of a child requires parents to make changes in their usual parenting role. In describing the nature of the changes required, parents identified the need to understand the illness experience; become familiar with the hospital environment; adapt to their changing relationship with the child and other family members; and negotiate with health professionals about their child's care. Verbatim accounts are used in this paper to illustrate parents' interpretations of their hospital experience. Parents perceive their role in their hospitalized child's care differently than health professionals do, and it would appear that much parental stress is attributable to the 'space' between health care workers' understanding of parents' experience, and parents' own comprehension. If nurses understood parents' own perception of their hospital-related stress better, more effective nursing care could be developed. Further research is needed in this important area.     

A survey of Chinese nurses' guidance to parents in children's postoperative pain relief

Aims and objectives. The aim of the study was to describe parental guidance provided by Chinese nurses regarding non‐pharmacological methods in children's surgical pain relief as well as factors related to this. Background. Parental involvement in children's pain management has been acknowledged and encouraged in recent years. However, parents’ lack of related information has been pointed out and little is known about how parents are guided to use non‐pharmacological methods to relieve the pain. Methods. A previously validated European questionnaire survey was conducted in 2002. Structured questionnaires were distributed to all 187 nurses working at 12 surgical wards in five hospitals of Fujian Province, China. The average response rate was 98%. Results. The results show that nurses informed parents of the majority of cognitive information. The most commonly guided non‐pharmacological methods were distraction, positive reinforcement, comforting/reassurance, positioning and relaxation. Nurses’ background factors, including age, education, nursing position, professional work experience, number of their own children and experiences of earlier hospitalizations of their children, were significantly related to their perceptions regarding parental guidance. Conclusions. Chinese nurses provided much guidance to parents on non‐pharmacological methods. However, the results show that sensory information and physical methods were poorly conveyed to parents, which needs future attention to reinforce parents’ active role in pain management. Relevance to clinical practice. This study provides new information on Chinese nurses’ guiding parents to use non‐pharmacological methods in pain alleviation, thereby contributing to the body of knowledge on this subject. Furthermore, the study makes the respondents aware of the importance of involving parents in their child's pain management.     

一位淋巴癌患儿父母亲对其教养态度和行为改变之探讨

探讨一个癌症家庭因孩子罹患淋巴癌后其父母对其教养态度及行为改变的因素。笔者于某医学中心儿科病房实习期间，观察整个家庭于患儿住院期间父母亲与患儿的互动模式。结果发现，罹患癌症患儿父母的教养态度和行为，会因患儿罹患癌症的疾病而有“父母亲准许患儿对父母生气”、“父母亲较会宠爱患儿”及“父母亲无法制定一套应遵守的生活规定来教育患儿”等3点明显的状况出现在此次照护患儿个案的家庭中；此篇文章研究结果，期可作为儿科病房护理人员在临床上照护此类癌症患儿以及未来发展父母亲教养患儿态度的架构之参考。     

Singaporean nurses' provision of guidance to parents on non-pharmacological postoperative pain-relief methods: An educational intervention study

This study examined the impact of an educational intervention (booklet distribution and lectures) on Singaporean nurses' provision of guidance to parents on the use of non-pharmacological methods of pain relief for their child's postoperative pain. Using a quasi-experimental one-group pre- and post-test study design, 134 and 112 registered nurses completed the questionnaires pre- and post-test, respectively. More than 75% of the nurses "always" guided parents to use breathing techniques, relaxation, positioning, comforting/reassurance, helping with activities of daily living, and creating a comfortable environment in the pretest and touch, presence, and distraction in addition to the aforementioned methods in the post-test. The nurses' provision of guidance to parents on all non-pharmacological methods increased, but statistically significant increases only were found in relation to massage and positive reinforcement. The results suggested that the educational intervention had some impact on nurses' provision of guidance to parents on the use of non-pharmacological methods of pain relief for children's postoperative pain. Continuing education in pain management should be provided to nurses in order to equip them with the knowledge to improve their practice.     

Parents' perceptions of their 1-6-year-old children's pain.

BACKGROUND OF THE STUDY: Parents' perceptions of children's pain may have influence on how children's postoperative pain is alleviated at home after discharge from hospital. PURPOSE OF THE STUDY: To describe parents' perceptions of 1-6-year-old children's pain. METHODS: Mothers (N=201) and fathers (N=114) whose child had undergone a day surgery in 10 Finnish central hospitals between October 2000 and September 2001 filled in a questionnaire including statements of pain perceptions, a Visual Analogue Scale to assess children's pain intensity and Parents' Postoperative Pain Measure (PPPM) to measure children's pain behaviours. RESULTS: Most of the parents suggested that adults have the responsibility to alleviate child's pain and that alleviation of child's postoperative pain prevents the child's fears during future visits in child welfare clinic. However, majority of parents described that postoperative pain decreases every day or that pain is always a part of surgery. Differences in parents' perceptions were found by both parents' and children's background variables. Parents' perceptions of children's pain were related to children's pain intensity and pain behaviours after surgery. CONCLUSIONS: Parents' perceptions of children's pain were related to children's pain after surgery at home. Adequate information of children's pain should be provided to the parents before discharge to promote children's pain alleviation at home. Special attention should be paid on parents' expectations of boys' higher pain tolerance.