Is caregiver refusal of analgesics a barrier to pediatric emergency pain management? A cross-sectional study in two Canadian centres

Whiston, Caroline; Ali, Samina; Wright, Bruce; Wonnacott, David; Stang, Antonia; Thompson, Graham; Bhat, Chirag; Todorovich, Sydney; Mishra, Ashutosh; Laczko, Dora; Miller, Michael R.; Poonai, Naveen

doi:10.1017/cem.2018.11

Cited by 12 publications

(6 citation statements)

References 61 publications

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“…Twycross 35 reported that children sometimes refused to take analgesic drugs offered to them. Other barriers relate to a lack of cooperation by parents 36 , although this is not a universally supported finding 37 . A frequent finding in pediatric pain research is the need for improved communication and emotional support for the parents 38,39 .…”

Section: Ways Of Knowing and Its Application To Pain In Cypmentioning

confidence: 99%

“…Other barriers relate to a lack of cooperation by parents 36 , although this is not a universally supported finding. 37 A frequent finding in pediatric pain research is the need for improved communication and emotional support for the parents. 38 , 39 These findings show how nurses’ ability to build a good working relationship with CYP and parents is vital, and how within that relationship the nurse must be a listener, nurturer, teacher, and information source.…”

Section: Ways Of Knowing and Its Application To Pain In Cypmentioning

confidence: 99%

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Using ways of knowing in nursing to develop educational strategies that support knowledge mobilization

Swift

Twycross

2020

Paediatric and Neonatal Pain

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There are continued challenges in achieving effective pain management for children and young people (CYP). Research has found several barriers to effective CYP pain management, which include, but are not limited to, deficiencies in knowledge among nurses and other healthcare professionals. Calls for improvements in and an increase in pain education ensue, in the expectation that an increase in knowledge will lead to an improved pain care for patients. Educational initiatives, as reported in the literature, have tended to focus on increasing empirical knowledge which has not resulted in the anticipated improvements in practice. An exploration of Carper's and Chinn & Kramer's five ways of knowing helps demonstrate why an over‐reliance on empirics fails to equip nurses for the realities of clinical practice and does not facilitate knowledge mobilization or improvements in pain care for CYP. In this paper, we explore these ways of knowing to produce a model for knowledge mobilization in (pain) education. Our model puts forward a multifaceted approach to education using the active learning principles which supports and equip nurses to become effective pain practitioners.

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Section: Ways Of Knowing and Its Application To Pain In Cypmentioning

confidence: 99%

Section: Ways Of Knowing and Its Application To Pain In Cypmentioning

confidence: 99%

Using ways of knowing in nursing to develop educational strategies that support knowledge mobilization

Swift

Twycross

2020

Paediatric and Neonatal Pain

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“…A summary of the management of TDIs in the primary dentition includes the following: A child's maturity and ability to cope with the emergency situation, the time for shedding of the injured tooth, and the occlusion are all important factors that influence treatment. It is critical that parents are given appropriate advice on how best to manage the acute symptoms to avoid further distress 48,49 . Luxation injuries, such as intrusion and lateral luxation, and root fractures may cause severe pain.…”

Section: Introductionmentioning

confidence: 99%

International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 3. Injuries in the primary dentition

Day

Flores

O’Connell

et al. 2020

Dental Traumatology

221

262

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Traumatic injuries to the primary dentition present special problems that often require far different management when compared to that used for the permanent dentition. The International Association of Dental Traumatology (IADT) has developed these Guidelines as a consensus statement after a comprehensive review of the dental literature and working group discussions. Experienced researchers and clinicians from various specialties and the general dentistry community were included in the working group. In cases where the published data did not appear conclusive, recommendations were based on the consensus opinions or majority decisions of the working group. They were then reviewed and approved by the members of the IADT Board of Directors. The primary goal of these Guidelines is to provide clinicians with an approach for the immediate or urgent care of primary teeth injuries based on the best evidence provided by the literature and expert opinions. The IADT cannot, and does not, guarantee favorable outcomes from strict adherence to the Guidelines; however, the IADT believes their application can maximize the probability of favorable outcomes.

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“…Whiston et al found that caregivers had high acceptance of analgesia offered in the ED and they concluded that caregiver refusal of analgesia was not a major barrier to children's pain management (24). However, less than 10% of the children were offered opioids in their study, with the majority receiving ibuprofen and acetaminophen.…”

Section: Discussionmentioning

confidence: 98%

A two-centre survey of caregiver perspectives on opioid use for children’s acute pain management

Jun

Ali

Yaskina

et al. 2019

Paediatrics &Amp; Child Health

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Background Given the current opioid crisis, caregivers have mounting fears regarding the use of opioid medication in their children. We aimed to determine caregivers’ a) willingness to accept, b) reasons for refusing, and c) past experiences with opioids. Methods A novel electronic survey of caregivers of children aged 4 to 16 years who had an acute musculoskeletal injury and presented to two Canadian paediatric emergency departments (ED) (March to November 2017). Primary outcome was caregiver willingness to accept opioids for moderate pain for their children. Results Five hundred and seventeen caregivers participated; mean age was 40.9 (SD 7.1) years with 70.0% (362/517) mothers. Children included 62.2% (321/516) males with a mean age of 10.0 (SD 3.6) years. 49.6% of caregivers (254/512) reported willingness to accept opioids for ongoing moderate pain in the ED, while 37.1% (190/512) were ‘unsure’; 33.2% (170/512) of caregivers would accept opioids for at-home use, but 45.5% (233/512) were ‘unsure’. Caregivers’ primary concerns were side effects, overdose, addiction, and masking of diagnosis. Caregiver fear of addiction (odds ratio [OR] 1.12, 95% confidence interval [CI] 1.01 to 1.25) and side effects (OR 1.25, 95% CI 1.11 to 1.42) affected willingness to accept opioids in the emergency department; fears of addiction (OR 1.19, 95% CI 1.07 to 1.32), and overdose (OR 1.15, 95% CI 1.04 to 1.27) affected willingness to accept opioids for at-home use. Conclusions Only half of the caregivers would accept opioids for moderate pain, despite ongoing pain following nonopioid analgesics. Caregivers’ fears of addiction, side effects, overdose, and masking diagnosis may have influenced their responses. These findings are a first step in understanding caregiver analgesic decision making.

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Is caregiver refusal of analgesics a barrier to pediatric emergency pain management? A cross-sectional study in two Canadian centres

Cited by 12 publications

References 61 publications

Using ways of knowing in nursing to develop educational strategies that support knowledge mobilization

Using ways of knowing in nursing to develop educational strategies that support knowledge mobilization

International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 3. Injuries in the primary dentition

A two-centre survey of caregiver perspectives on opioid use for children’s acute pain management

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