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.     

Parent involvement in children''s pain care: views of parents and nurses

AIM OF THE STUDY: This study investigated the views of parents and nurses about the involvement of parents in the management of their child's pain during the first 48 hours after surgery. BACKGROUND: Children's pain management has been found to be problematic and in need of improvement. Nurses are the key health care professionals with responsibility for managing children's pain. Parents can make important contributions to assessment and management of their child's pain. METHODS: Using a phenomenological approach, nurses and parents were interviewed about their perceptions of parent involvement in pain management. FINDINGS: The findings indicated that parental involvement in their child's pain management is superficial and limited in nature. Parents described a passive role in relation to their child's pain care and conveyed feelings of frustration. Only a minority of parents expressed satisfaction with their child's pain care. Nurses perceived that there was adequate involvement of parents and adequate pain management for children. CONCLUSIONS: These findings may be somewhat explained by differing views and a lack of effective communication between parents and nurses. There is a clear need for nurses to discuss parent involvement with parents and negotiate roles in relation to pain management.     

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.     

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.     

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.     

Validity of Parent Ratings as Proxy Measures of Pain in Children with Cognitive Impairment

Parent-assigned pain scores have been used as proxy measures of pain for children, such as those with cognitive impairment (CI), who cannot self-report. However, the accuracy of parent-assigned pain ratings for children with CI has not been studied. This study evaluated the construct and criterion validity of parental pain scores of children with CI. Fifty-two children aged 4 to 19 years with CI and their parents/guardians were included in this observational study. Children were observed and assessed for pain by parents using the Faces, Legs, Activity, Cry, and Consolability (FLACC) observational tool and the 0 to 10 Numbers Scale, and simultaneously by nurses using the FLACC. Children who were cognitively able scored pain using simplified scales. Parent scores decreased after analgesic administration (6.4 +/- 2.5 vs. 3.1 +/- 2.3; p = .004), supporting their construct validity. Parents' FLACC and Numbers ratings correlated well with nurse ratings (intraclass correlation coefficient = 0.78 [confidence interval = 0.63-0.87] and intraclass correlation coefficient = 0.73 [confidence interval = 0.59-0.83], respectively). The parents' coded Numbers ratings correlated moderately with their child's ratings (rho = 0.57; p = .05) and agreed in 20% to 100% of cases (kappa = 0.388). There was better overall agreement between parents' FLACC scores and child ratings (33%-67% agreement; kappa = 0.43). The parent underestimated the child's pain with FLACC ratings in only one case (8%), but overestimated pain in three cases (25%). This study suggests that parents of children with CI provide reasonable estimates of their child's pain, particularly when using a structured pain tool. Parents may, however, tend to overestimate their child's pain during the early postoperative period.     

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.     

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.     

Parental perceptions of the preschool obese child

Childhood obesity is a serious public health problem today with many potential complications and adverse outcomes for children. How parents view their children's weight is an important consideration for nurses. The purpose of this study was to increase staff understanding of parents' views so that interventions could be developed to achieve improved outcomes in attenuating the rate of weight gain in obese children. A questionnaire was administered to 200 parents, mostly Hispanic, of obese children to determine the parents' perceptions of their child's obesity. The study revealed that 35% of parents did not believe their obese child was overweight and 53% had no problem controlling what their child eats. However, 78% of parents expressed concern about heart disease as a consequence of childhood obesity. The study demonstrated that parents acknowledge some health risks of obesity but that interventions in treating childhood obesity need to begin with the understanding of parents' perceptions of their own child's obesity.     

Parents' perceptions of their child's acute pain experience

Painful procedures, experienced by many pediatric patients early in their admission, have been identified by parents in our clinical practice as a source of stress. The purpose of this study was to examine parents' perceptions and concerns about their child's acute pain experience. A convenience sample of 71 parents of 62 children was given a questionnaire that focused on the child's pain intensity, the behaviors that indicated the child was in pain, and the parents' preparation for and involvement in the child's pain experience. The majority of parents were asking for more information about and greater participation in procedures that caused their child pain.     

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.     

The child's advocate in donor conceptions: the telling of the story

Parents who use donor gametes should feel firm and entitled to say they are this child's parents. Health care providers (doctors, nurses, and social workers) must help these parents. Their decision to bring a child into the world creates continuous consequences for the whole family. The parents' responsibility is to attach, parent, and educate, and the child's responsibility is to ask questions to form an identity and find ways to feel secure about the individual he or she is becoming. Participating as the child's advocate presents many joys and celebrations, as well as many challenges. Pediatric nurses can help families resolve infertility issues and obtain education about donor conception. This advocacy provides the freedom for parents to be proud of their decision, attach to the process, and rejoice for the child who comes to their family. This is a true blessing for everyone.     

Assessment of acute pediatric pain: do child self-report, parent ratings, and nurse ratings measure the same phenomenon?

The purpose of this study was to determine the factors that are associated with child, parent, and nurse ratings of acute pediatric pain and distress during venipuncture. The behavior of eighty-five pediatric cancer patients during venipuncture was recorded by trained raters, and their observations were compared with ratings of pain and distress obtained from parents, pediatric patients, and pediatric nurses. Regression analyses indicated that ratings made by the child, parent, and nurse reflect different perspectives. Nurses' ratings were based upon overt distress, parents' ratings reflected their subjective perception of the child's pain, and the child's self-report was associated with the child's chronologic age.     

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.     

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.     

Needs assessment and intervention strategies to reduce lead-poisoning risk among low-income Ohio toddlers

OBJECTIVE: Examine parental receipt of lead-poisoning prevention information and preferred methods of receiving this information. DESIGN: Cross-sectional mailed survey of parents with children 1-2-year-old-enrolled in Medicaid. SAMPLE: Respondents (n=532) were primarily female, white, with at least a high school education, and between the ages of 20-30 years. MEASUREMENTS: Items from the Blood Lead Education and Screening Tool concerning parental receipt of lead-poisoning prevention information, persons with whom parents had discussed lead-poisoning prevention, parental receipt of a reminder about blood lead testing, and parents' preferred methods of obtaining lead-poisoning prevention information. RESULTS: Most respondents had obtained lead-poisoning prevention information, but only 28% reported receiving a reminder to have their child's blood lead level assessed. Brochures and discussions with health care providers were the preferred methods of obtaining lead-poisoning prevention information. More minority respondents preferred receiving information via videos, billboards, and home visits. Younger parents preferred brochures, billboards, and speaking with someone at the health department or women, infants, and children supplemental nutrition (WIC). Most respondents identified multiple means by which they would like to receive lead-poisoning prevention information. CONCLUSIONS: Implementation of individual, community, and system-level interventions by public health nurses are needed for comprehensive lead-poisoning prevention education.     

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.