Parental involvement in postoperative pain management among children in a urology ward: A best practice implementation project

Abstract

Aim Postoperative pain has adverse effects on children with urological problems, including sleep disturbances, incision dehiscence, bleeding and delayed recovery. Accurate parental assessment of children's behaviours and responses could help to manage postoperative pain. We aimed to implement evidence‐based practice for parental involvement in a urology ward, to increase parents' participation in children's postoperative pain management. Design The project was conducted in a paediatric urology ward using the framework and methods of the Fudan University Evidence‐Based Nursing Center's Evidence‐based Continuous Quality Improvement Model. Methods Fifteen audit criteria were used to represent best practice recommendations for parental involvement in postoperative pain management. A pre‐implementation audit was conducted with 211 randomly sampled children and parents. Obstacles, promoting factors and key strategies were analysed, and evidence‐based interventions implemented to improve compliance. A follow‐up audit using the same audit criteria was conducted with 202 children and parents to assess the effect of targeted strategies on compliance with best practice. The SQUIRE guidelines were followed. Results At the baseline audit, compliance with the evidence‐based criteria was 0%–71.5%; only five audit criteria achieved a compliance rate > 60%. After best practice implementation, the follow‐up audit showed compliance improvements for all criteria; compliance for three criteria improved to 100%. Patient or Public Contribution This best practice implementation project improved parents' participation in children's postoperative pain management. The findings demonstrate how audits can promote best practice in postoperative pain management for children. Additional studies will be conducted to address children's postoperative life quality based on best practice.

Process Evaluation of a Pain Management Educational Intervention for Parents of Children Undergoing Elective Surgery

“…As such, non-pharmacological pain management strategies may be suggested as they are known to be applicable for patients in all age groups and are effective in relieving pain, with and without additional pharmacological intervention [12,[22][23][24][25]. Our findings were congruent with a best practice implementation project in that postoperative pain management practices remain suboptimal and non-pharmacological methods were not used as there was a lack of education provided to parents [3]. Pain medications are currently the primary strategy used in the hospital setting to control children's pain, and nurses in Singapore do not commonly apply non-pharmacological methods.…”

“…Pain medications are currently the primary strategy used in the hospital setting to control children's pain, and nurses in Singapore do not commonly apply non-pharmacological methods. The inadequacy in adopting non-pharmacological pain relief methods may be attributed to the nurses' concerns about an anticipated increase in workload or their lack of knowledge and expertise on these strategies [3,26] 3. Valizadeh et al [27] also suggested that some nurses might lack sensitivity and awareness of patients' pain management needs, which diminishes their application of these non-pharmacological methods.…”

“…Likewise, several other studies also revealed that parents have consistently expressed the need for information and guidance from nurses regarding their children's postoperative pain management [6]. Empowering parents to be involved in their children's pain management has been identified as an important element in delivering effective pain management [3,7]. These studies highlight the immense need to educate parents and equip them with relevant knowledge and skills in pain management [7,8].…”

“…Over the past few decades, parental involvement in their children's care in the hospital has increased [1][2][3], and this has been found to benefit both parents and their children [1]. However, previous studies have indicated that parents often lacked knowledge of their children's postoperative pain management [4,5], such as available pain relief strategies, especially those regarding nonpharmacological methods of pain management [4].…”

Regional anesthesia for pain control in children with solid tumors—a review of case reports

“…Children are thought to lack the capacity to comprehensively deliver the severity of their pain, causing most pain to be left untreated in almost half of the postoperative pediatric patients ( 9 ). According to Yang ( 82 ), as primary caregivers, the parents can deliver a better assessment of their child's pain to medical staff, thus improving the quality of pain management and building trust-based relationships between them. The evidence suggests reduced physical and emotional distress once parents can participate in managing physical care after their child ( 83 ).…”