Children’s experience of postoperative pain relief: children, parents and nurses use various pharmacological and non-pharmacological approaches, particularly distraction
- Correspondence to: Dr Joan Simons, Faculty of Health and Social Care, The Open University, Walton Hall, Milton Keynes, Buckinghamshire MK7 6AA, UK;
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.
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.
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.
Pain scores ranged from 2 to 10 on the numeric pain rating scale. Paracetamol and ibuprofen were the most commonly administer 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’.
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 self-report 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.