Procedural pain in children: a qualitative study of caregiver experiences and information needs

Kassi Shave, Samina Ali, Shannon D Scott, Lisa Hartling, Kassi Shave, Samina Ali, Shannon D Scott, Lisa Hartling

Abstract

Background: Children experience multiple painful procedures when being cared for in emergency departments (EDs). Unfortunately, evidence-based interventions to manage such pain and distress are under-utilized across EDs. Caregivers are uniquely positioned and invested to advocate for the adaptation of such evidence into practice. Our objective was to gather information from caregivers of children experiencing procedural pain in the ED to inform the development of a novel, caregiver-focused knowledge translation (KT) tool.

Methods: The study design was qualitative description. Caregivers of children who underwent intravenous (IV) insertion or venipuncture in the pediatric ED at an urban tertiary care centre were interviewed. Thematic analysis was applied to the data. The TRanslating Emergency Knowledge for Kids (TREKK) Parent Advisory Group continuously informed this study, and provided input on interview guide development and piloting, data collection, analysis of the data, interpretation of the results, and development of next steps.

Results: Interviews revealed four major themes: 1) source of healthcare information; 2) delivering healthcare information; 3) communication with caregivers; and 4) procedure-related anxiety and long-term effects. Caregivers most valued receiving information directly from their healthcare provider. They also expressed that healthcare providers should direct information about the procedure to their child and identified strategies to involve children in their care. Caregivers wanted to be empowered to ask informed questions of their healthcare providers. Finally, caregivers reported negative experiences with procedures for their children, occurring mainly at non-pediatric centres.

Conclusions: We have identified core information needs for caregivers whose children are experiencing IV insertion or venipuncture. These results will form the foundation for the development of a KT tool that may empower caregivers to actively participate in their child's healthcare.

Keywords: Children; Emergency department; Intravenous; Knowledge translation; Pediatrics; Procedural pain; Venipuncture.

Conflict of interest statement

Ethics approval and consent to participate

Institutional ethics approval was obtained for this study from the University of Alberta Health Research Ethics Board. Written informed consent was obtained from all study participants.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

    1. American Academy of Pediatrics Committee on Psychosocial Aspects of Child and Family Health The assessment and management of acute pain in infants, children, and adolescents. Pediatrics. 2001;108(3):793–797. doi: 10.1542/peds.108.3.793.
    1. Drendel AL, Kelly BT, Ali S. Pain assessment for children: overcoming challenges and optimizing care. Pediatr Emerg Care. 2011;27(8):773–781. doi: 10.1097/PEC.0b013e31822877f7.
    1. Stang AS, Hartling L, Fera C, Johnson D, Ali S. Quality indicators for the assessment and management of pain in the emergency department: a systematic review. Pain Res Manag. 2014;19(6):179–190. doi: 10.1155/2014/269140.
    1. Curtis S, Wingert A, Ali S. The Cochrane library and procedural pain in children: an overview of reviews. Evid Based Child Health. 2012;7(5):1363–1399. doi: 10.1002/ebch.1864.
    1. Watt-Watson J, Clark AJ, Finley GA, Watson CPN. Canadian Pain Society position statement on pain relief. Pain Res Manag. 1999;4(2):75–78. doi: 10.1155/1999/643017.
    1. Max MB, Donovan M, Miaskowski CA, Ward SE, Gordon D, Bookbinder M, et al. Quality improvement guidelines for the treatment of acute pain and cancer pain. JAMA. 1995;274(23):1874–1880. doi: 10.1001/jama.1995.03530230060032.
    1. Keels E, Sethna N, Watterberg KL, Cummings JJ, Benitz WE, Eichenwald EC, et al. Prevention and Management of Procedural Pain in the neonate: an update. Pediatrics. 2016;137(2):1–13.
    1. Stevens BJ, Abbott LK, Yamada J, Harrison D, Stinson J, Taddio A, et al. Epidemiology and management of painful procedures in children in Canadian hospitals. CMAJ. 2011;183(7):e403–e410. doi: 10.1503/cmaj.101341.
    1. Stinson J, Yamada J, Dickson A, Lamba J, Stevens B. Review of systematic reviews on acute procedural pain in children in the hospital setting. Pain Res Manag. 2008;13(1):51–57. doi: 10.1155/2008/465891.
    1. Yamada J, Stinson J, Lamba J, Dickson A, McGrath PJ, Stevens B. A review of systematic reviews on pain interventions in hospitalized infants. Pain Res Manag. 2008;13(5):413–420. doi: 10.1155/2008/232316.
    1. Carbajal R, Rousset A, Danan C, Coquery S, Nolent P, Ducrocq S, et al. Epidemiology and treatment of painful procedures in neonates in intensive care units. JAMA. 2008;300(1):60–70. doi: 10.1001/jama.300.1.60.
    1. Cordell WH, Keene KK, Giles BK, Jones JB, Jones JH, Brizendine EJ. The high prevalence of pain in emergency medical care. Am J Emerg Med. 2002;20(3):165–169. doi: 10.1053/ajem.2002.32643.
    1. Kennedy RM, Luhmann J, Zempsky WT. Clinical implications of unmanaged needle-insertion pain and distress in children. Pediatrics. 2008;122(3):S130–S133. doi: 10.1542/peds.2008-1055e.
    1. von Baeyer CL, Marche TA, Rocha EM, Salmon K. Children’s memory for pain: overview and implications for practice. J Pain. 2004;5(5):241–249. doi: 10.1016/j.jpain.2004.05.001.
    1. Smith RW, Shah V, Goldman RD, Taddio A. Caregivers’ responses to pain in their children in the emergency department. Arch Pediatr Adolesc Med. 2007;161(6):578–582. doi: 10.1001/archpedi.161.6.578.
    1. Ali S, McGrath T, Drendel AL. An evidence-based approach to minimizing acute procedural pain in the emergency department and beyond. Pediatr Emerg Care. 2016;32(1):36–42. doi: 10.1097/PEC.0000000000000669.
    1. Ali S, Chambers A, Johnson DW, Newton AS, Vandermeer B, Williamson J, et al. Reported practice variation in pediatric pain management: a survey of Canadian pediatric emergency physicians. CJEM. 2014;16(5):352–360. doi: 10.2310/8000.2013.131261.
    1. Ali S, Chambers AL, Johnson DW, Craig WR, Newton AS, Vandermeer B, et al. Paediatric pain management practice and policies across Alberta emergency departments. Paediatr Child Health. 2014;19(4):190–194. doi: 10.1093/pch/19.4.190.
    1. Hartling L, Scott S, Pandya R, Johnson D, Bishop T, Klassen TP. Storytelling as a communication tool for health consumers: development of an intervention for parents of children with croup. Stories to communicate health information. BMC Pediatr. 2010;10:64. doi: 10.1186/1471-2431-10-64.
    1. Hartling L, Scott SD, Johnson DW, Bishop T, Klassen TP. A randomized controlled trial of storytelling as a communication tool. PLoS One. 2013;8(10):e77800. doi: 10.1371/journal.pone.0077800.
    1. Levy MM, Dellinger RP, Townsend SR, Linde-Zwirble WT, Marshall JC, Bion J, et al. The surviving Sepsis campaign: results of an international guideline-based performance improvement program targeting severe sepsis. Intensive Care Med. 2010;36(2):222–231. doi: 10.1007/s00134-009-1738-3.
    1. Stevens BJ, Yamada J, Estabrooks CA, Stinson J, Campbell F, Scott SD, et al. Pain in hospitalized children: effect of a multidimensional knowledge translation strategy on pain process and clinical outcomes. Pain. 2014;155(1):60–68. doi: 10.1016/j.pain.2013.09.007.
    1. Taddio A, Shah V, Leung E, Wang J, Parikh C, Smart S, et al. Knowledge translation of the HELPinKIDS clinical practice guideline for managing childhood vaccination pain: usability and knowledge uptake of educational materials directed to new parents. BMC Pediatr. 2013;13:23. doi: 10.1186/1471-2431-13-23.
    1. Ellis JA, McCleary L, Blouin R, Dube K, Rowley B, MacNeil M. Implementing best practice pain management in a pediatric hospital. J Spec Pediatr Nurs. 2007;12(4):264–277. doi: 10.1111/j.1744-6155.2007.00121.x.
    1. Lawes C, Sawyer L, Amos S, Kandiah M, Pearce L, Symons J. Impact of an education programme for staff working with children undergoing painful procedures. Paediatr Nurs. 2008;20(2):33–37. doi: 10.7748/paed2008.03.20.2.33.c6528.
    1. Kavanagh T, Stevens B, Seers K, Sidani S, Watt-Watson J. Process evaluation of appreciative inquiry to translate pain management evidence into pediatric nursing practice. Implement Sci. 2010;5:90. doi: 10.1186/1748-5908-5-90.
    1. Zhu LM, Stinson J, Palozzi L, Weingarten K, Hogan ME, Duong S, et al. Improvements in pain outcomes in a Canadian pediatric teaching hospital following implementation of a multifaceted knowledge translation initiative. Pain Res Manag. 2012;17(3):173–179. doi: 10.1155/2012/586589.
    1. Gagnon Michelle M., Hadjistavropoulos Thomas, Hampton Amy J. D., Stinson Jennifer. A Systematic Review of Knowledge Translation (KT) in Pediatric Pain. The Clinical Journal of Pain. 2016;32(11):972–990. doi: 10.1097/AJP.0000000000000345.
    1. Coleman EA, Smith JD, Frank JC, Min SJ, Parry C, Kramer AM. Preparing patients and caregivers to participate in care delivered across settings: the care transitions intervention. J Am Geriatr Soc. 2004;52(11):1817–1825. doi: 10.1111/j.1532-5415.2004.52504.x.
    1. Krauss MJ, Tutlam N, Costantinou E, Johnson S, Jackson D, Fraser VJ. Intervention to prevent falls on the medical service in a teaching hospital. Infect Control Hosp Epidemiol. 2008;29(6):539–545. doi: 10.1086/588222.
    1. Sandelowski M. What’s in a name? Qualitative Description Revisited. Res Nurs Health. 2010;33(1):77–84.
    1. Stollery Children’s Hospital Foundation. General Impact Report. . Accessed 8 Sept 2016.
    1. Palys T. Purposive sampling. In: Given LM, editor. The SAGE encyclopedia of qualitative research methods. Thousand oaks: SAGE Publications; 2008. pp. 697–698.
    1. Morse JM. The significance of saturation. Qual Health Res. 1995;5(2):147–149. doi: 10.1177/104973239500500201.
    1. Morse JM, Field PA. Qualitative research methods for health professionals. 2. Thousand Oaks: SAGE Publications; 1995.
    1. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101. doi: 10.1191/1478088706qp063oa.
    1. Guba EG. Criteria for assessing the trustworthiness of naturalistic inquiries. ECTJ. 1981;29(2):75–91.
    1. Thomas D, Kircher J, Plint AC, Fitzpatrick E, Newton AS, Rosychuk RJ, et al. Pediatric pain Management in the Emergency Department: the triage Nurses’ perspective. J Emerg Nurs. 2015;41(5):407–413. doi: 10.1016/j.jen.2015.02.012.
    1. Byczkowski TL, Gillespie GL, Kennebeck SS, Fitzgerald MR, Downing KA, Alessandrini EA. Family-centered pediatric emergency care: a framework for measuring what parents want and value. Acad Pediatr. 2016;16(4):327–335. doi: 10.1016/j.acap.2015.08.011.
    1. Ali S, Weingarten LE. Kircher, dong K, Drendel AL, Rosychuk RJ, et al. a survey of caregiver perspectives on Children's pain management in the emergency department. CJEM. 2016;18(2):98–105. doi: 10.1017/cem.2015.68.
    1. Downey LV, Zun LS. Pain management in the emergency department and its relationship to patient satisfaction. J Emerg Trauma Shock. 2010;3(4):326–330. doi: 10.4103/0974-2700.70749.
    1. Children's Hospital of Eastern Ontario. Be sweet to babies. 2016. . Accessed 8 Sept 2016.
    1. Alberta Health Services. New ED pain program debuts at ACH. 2016. . Accessed 8 Sept 2016.
    1. Canadian Institutes of Health Research. It doesn’t have to hurt. 2016. . Accessed 8 Sept 2016.
    1. Taddio A, Soin HK, Schuh S, Koren G, Scolnik D. Liposomal lidocaine to improve procedural success rates and reduce procedural pain among children: a randomized controlled trial. CMAJ. 2005;172(13):1691–1695. doi: 10.1503/cmaj.045316.
    1. Corwin DJ, Kessler DO, Auerbach M, Liang A, Kristinsson G. An intervention to improve pain management in the pediatric emergency department. Pediatr Emerg Care. 2012;28(6):524–528. doi: 10.1097/PEC.0b013e3182587d27.
    1. Canadian Institute of Health Information. Analysis in brief: Emergency departments and children in Ontario. 2008. . Accessed 8 Sept 2016.
    1. The Canadian Association of Emergency Physicians. Emergency medicine: Change and challenge: The Canadian Association of Emergency Physicians’ submission to the Commission of the Future of Health Care in Canada. 2001. . Accessed 8 Sept 2016.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться