Parents' management of their child's postoperative pain

In spite of its benefits, day or minor surgery is not without complications; pain is a significant issue for someatients (Kotiniemi et al 1997, Grenier et al 1998). Having witnessed considerable variation in the discharge advice given to parents about pain control we were prompted to discover what evidence there is to suggest 4 hat parents can effectively manage their child's postoperative pain at home following day or minor surgery. In this artide cle review the evidence and describe how review findings were used to inform practice.     

Parents' perceptions of their infant's pain experience in the NICU

Despite numerous advances in the recognition, assessment, and management of pain in neonates over the past two decades, there has been limited improvement in the knowledge base regarding parental responses to their infant's pain. This study examined parents' views of their experiences observing and coping with their infant's pain in the neonatal intensive care unit (NICU). Twelve participants were recruited using purposive sampling from two groups: (a) parents who had infants currently receiving care in the NICU (n=6); and (b) parents whose infants had been discharged from the NICU and were enrolled in the outpatient follow-up clinic at each hospital (n=6). An exploratory, semi-structured format was used to interview parents individually (n=5) or in focus groups (n=7) regarding their infant's clinical course, infant pain experiences, and the parenting experience during and after the NICU stay. Thematic content analysis was used to develop conceptual categories. Two broad themes were identified: (a) infant pain as a source of parental distress and (b) relief of parental distress due to infant's pain.     

Parents' perceptions of the information provided to them about their child's leukaemia.

Forty-one mothers and 30 fathers were interviewed to examine their perceptions of (a) the type and amount of information provided to them about their child's leukaemia; (b) their sources of information; (c) their level of satisfaction from the information given; and (d) additional information they needed to manage the stressful encounters associated with the disease. Study results showed that health-care professionals represented the main source of information for these parents. The information given was centred primarily on the bio-medical aspects of the child's condition. Parents, however, reported that they needed additional information related to the psychosocial ramifications of the situation. No statistically significant differences were found either between the two sexes or between the two spouses. Education and previous experience with cancer correlated both to perceived amount of information given and to parental satisfaction from it. Subjects' low satisfaction from the information offered to them seems to reflect their disappointment about (a) the limited effectiveness of current medical knowledge and treatment and (b) the bio-clinical focus of the Hellenic health-care system.     

Parents' roles in using non-pharmacological methods in their child's postoperative pain alleviation

Increasingly nowadays, parents participate more fully in the care of their hospitalized children. The purpose of this study was to describe parents' utilization of selected non-pharmacological methods in relieving their hospitalized child's (aged 8-12 years) postoperative pain, and factors related to this function. Data were collected by a questionnaire survey completed by parents (n=192) with a child hospitalized on a paediatric surgical ward in the five university hospitals of Finland. The response rate was 90%. Results indicated that non-pharmacological methods, such as emotional support and helping with daily activities, were well utilized whereas cognitive-behavioural and physical methods were less frequently used strategies. Certain background factors specific to the parents and their hospitalized children were significantly related to the non-pharmacological methods used by the parents. The hospitalized child's gender, the time of the surgical procedure, and the parents' assessments of their child's pain intensity, were especially significantly related to many of these strategies. The findings of this study could be used in clinical practice to improve guidance provided to parents regarding interventions for children's pain relief.     

Parents' perceptions of the miscarriage experience

This study was conducted to examine parents' perceptions of miscarriage. Participants were six married couples who experienced a miscarriage 12-18 months prior to data collection. Data were collected during three open-ended interviews with each subject. The analysis process involved identifying miscarriage events and their significance and the standard of the desirable against which the experience was evaluated. Participants who experienced the most intense grief appeared to be those for whom the pregnancy and baby were real, whose actual miscarriage was widely divergent from their epistemic orientation, and who perceived themselves as unable to act in ways to decrease this divergence.     

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.     

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.     

Parents' perceptions of their children's death concept

To examine the differences between parents' and nonparents' beliefs regarding the concept of death in children, 352 individuals answered a demographic survey. Questions concerning beliefs about the age at which children develop the concept of the irreversibility of death were included on the survey. Parents believed that the concept is developed at an earlier age than did nonparents, and also believed that the concept is developed at an earlier age than has been revealed by most research.     

Parents' perceptions of their newborn following structured interactions

A study of 57 married couples and their normal-term firstborn infants investigated (a) if parents' perceptions are related to behavior of infants and (b) if a structured interaction of parent with infant positively influences parents' perceptions of their infant. Mothers, fathers, or parents in three experimental groups participated in a structured interaction with their infants. Parents and infants in a control group received no structured interaction. The interaction consisted of the parents assessing their infant using the Mother's Assessment of the Behavior of Her Infant (MABI). Infants' behaviors were measured with the Neonatal Behavioral Assessment Scale (NBAS) and parents' perceptions with the Neonatal Perception Inventories (NPI). There was no relation between infant behavior and parental perception. The factor structure of NBAS items was similar to that found by other investigators. The structured interaction differentially affected perception scores of mothers at Time 2 (F 3, 53 = 3.96, p = .013). Perceptions of mothers and fathers achieved some congruence over time (Time 1, r = .18, p = .189; Time 2, r = .45, p = .001; Time 3, r = .41, p = .002). Seven other variables contributed more to variance in mothers' than fathers' perceptions.     

Parental emotional responses to their child's pain: the role of dispositional empathy and catastrophizing about their child's pain.

Little is known about how a child's experience of pain affects his or her parents. Using a vignette methodology, this study investigated the emotional responses of parents who were asked to imagine different painful situations that their child might experience. A sample of 650 parents of school children (325 mothers; 325 fathers) read 8 short stories/vignettes about their child, which varied in terms of type of situation (pain vs other stressful situation), intensity (high vs low), and frequency of occurrence (high vs low). The role of individual differences in parental catastrophizing about their child's pain, catastrophizing about their own pain, dispositional empathy, and gender was also investigated. Parents' dispositional empathy was found to have an impact on parental distress and concern for their child. Catastrophizing about their child's pain had a unique contribution to parents' emotional responses to the vignettes describing their child in pain, beyond the influence of other variables. The impact of parental catastrophizing about their child's pain was most pronounced for parental distress, probably reflecting the high threat value that they attribute to their child's pain. The findings are discussed within recent models of empathy and pain, delineating possible relationships with parents' behavioral responses to their child's pain. PERSPECTIVE: This vignette study found preliminary evidence for the importance of parent characteristics, beyond situational characteristics, in parental emotional responses to their child's pain. The findings provide indications for the processes implied in parental helping behavior.     

Parents' experiences of living through their child's suffering from and surviving severe meningococcal disease

The aim of this study was to describe the lived experience of parents whose child had suffered from and survived severe meningococcal disease. A Heideggerian phenomenological approach was used within the study and data were collected from long focused interviews. In total, eight parents took part in the study; one was a woman recruited as a pilot interview and the other seven were recruited for the main study. The data were analysed using Colaizzi's (1978) method. Eleven themes emerged: (1) complications/side effects; (2) emotional turmoil; (3) child's physical appearance; (4) family disruption; (5) fear of death; (6) loss of parenting role; (7) need for support and understanding; (8) need and value of communication, information and publicity; (9) parental intuition; (10) technological interventions and (11) the impact of care delivery. A review of the literature arising out of the data was undertaken, and a final synthesis statement as perceived by the parents was achieved. Living through this experience is perceived as a major emotional stressor, and although health professionals have some insight into the experience, they are largely naive to the enormity of the situation.     

Surviving childhood cancer: parents' perceptions of their child's health.

The improving prognosis for children with cancer refocuses attention to long-term outcomes. The purpose of this study was to assess whether changes in mothers' and fathers' perception of caregiving demands and well-being over a 1-year time period predicted parents' perception of their child's health at 12 months and to evaluate if these variables predicted change in health perceptions over a period of 1 year. Twenty Icelandic families of children younger than 18 years with cancer participated in the study. The change in general well-being over the year significantly predicted parents' perception of their child's health at 12 months; for the mothers, the change in well-being also predicted the changes in their perception of their child's health over the 1-year period. These findings suggest the importance of incorporating long-term health-related outcomes and measures to improve well-being among family members in future research and clinical practice, when caring for children and families surviving childhood cancer.     

Mothers' and fathers' responses to their child's pain moderate the relationship between the child's pain catastrophizing and disability

Preliminary evidence suggests that pain catastrophizing in children may be important in understanding how parents respond to their child’s pain. However, no study has investigated whether parental responses, in turn, moderate the impact of child’s catastrophizing upon pain outcomes. The present study was designed to address this, and investigated the association of the child’s catastrophizing with different types of parental responses (ie, solicitousness, discouragement and coping promoting responses) and the extent to which parental responses moderate the association between the child’s catastrophizing and disability. Participants were 386 school children and their parents. Analyses revealed significant associations between the child’s pain catastrophizing and parental responses, but with mothers and fathers evidencing different patterns; ie, higher levels of the child’s catastrophizing were significantly associated with lower levels of solicitousness by fathers, and with higher levels of discouragement by mothers. Moderation analyses indicated that father’s solicitiousness moderated the association between catastrophizing and disability; the positive association between catastrophizing and the child’s disability was further strengthened when fathers reported low levels of solicitousness, but became less pronounced when fathers reported high levels of solicitousness. Findings also revealed a moderating impact of mothers’ and fathers’ promotion of their child’s well behaviour/coping. Specifically, the detrimental impact of child catastrophizing upon disability was less pronounced when parents reported high promotion of their child’s well behaviours/coping. The findings of the present study suggest the importance of assessing and targeting parental responses to their child’s pain to alter the adverse impact of the child’s pain catastrophizing on pain outcomes.     

Parents who catastrophize about their child's pain prioritize attempts to control pain

How parents respond to their child in pain is critically important to how both parent and child attempt to cope with pain. We examined the influence of parental catastrophic thinking about child pain on their prioritization for pain control. Using a vignette methodology, parents reported, in response to different pain scenarios, on their imagined motivation for 2 competing goals: to control their child's pain (ie, pain control) or to encourage their child's participation in daily activities (ie, activity engagement). The effects of parent gender, pain intensity, and duration on parental goal priority were also explored. Findings indicated that higher levels of parental catastrophic thoughts were associated with the parents prioritizing child pain control over activity engagement. This effect was significantly moderated by pain duration. Specifically, pain control was more of a priority for those high in catastrophic thinking when the pain was more acute. In contrast, parental catastrophic thoughts had no effect on the pain control strategy favored by parents in situations with longer-lasting pain. Furthermore, independently of parental catastrophic thoughts, heightened priority for pain control was observed in highly intense and chronic pain situations. Moreover, in highly intense pain, priority for pain control was stronger for mothers compared with fathers. Theoretical and clinical implications and directions for future research are discussed.