Experiences of Teaching and Learning Pediatric Pain Management in Ghana.

BACKGROUND: The literature has revealed gaps in knowledge and attitudes regarding pediatric pain management among Ghanaian nurses and nursing students that can be attributed to inadequate education in the area. Consequently, nursing tutors teaching pain management might not have the appropriate knowledge to transfer to their students. PURPOSE: To explore nursing tutors' experiences of teaching pediatric pain management as well as their students' learning experiences before and after the tutors' training workshop. DESIGN: A descriptive qualitative design was employed for the conduct of the study. METHODS: Data were collected via focus groups from 32 tutors and 24 students before and after an educational workshop. Data analysis drew on Braun and Clarke's thematic analysis. FINDINGS: Pre-workshop themes revealed knowledge deficits regarding pediatric pain management in both tutors and students due to learning having occurred in bits and pieces. Furthermore, lack of accessibility to books and pain scales perpetuated this bits-and-pieces approach to learning. Post-workshop findings revealed gains in tutors' knowledge and skills. Consequently, students gained new insights into pediatric pain management. CONCLUSION: Tutors and student nurses had a knowledge deficit regarding pediatric pain management. The educational workshop and the provision of learning materials resulted in enhanced knowledge and attitudes that subsequently improved tutors' ability to effectively teach the topic to their students, with a clear implication for improvements in clinical practice. CLINICAL IMPLICATION: Educating nursing tutors about pediatric pain is imperative to enable students and thus future nurses to be equipped with the necessary evidence-based knowledge of how to manage pediatric pain.

Exploring the disaster experiences and psychosocial support needs of children affected by the Kahramanmaras earthquake in Turkey through drawing narratives.

BACKGROUND: On February 6, 2023, a catastrophic earthquake struck the Kahramanmaras region in Turkey. Among the most vulnerable demographic groups in the wake of such disasters are children. To provide effective psychosocial support to these young individuals, it is crucial to gain a comprehensive understanding of their specific needs resulting from the earthquake experience. OBJECTIVES: This study aimed to determine the disaster experiences and psychosocial support needs of children between the ages of 7 and 12 who were affected by the Kahramanmaras earthquake in Turkey with drawings. METHODS: This research used a descriptive qualitative design, employing purposive and snowball sampling approaches to select 32 children aged 7-12 for the study. Thematic analysis approach was used to analyze the data, revealing six distinct themes as expressed through the drawings of school-aged children. The reporting in this study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ). RESULTS: These six themes are associating precipitation with earthquakes, security and relocation, emotional chaos, expressing the earthquake symbolically, death and physical damage and longing for normalcy. CONCLUSIONS: This study highlights the importance of acknowledging and attending to children's requirements through psychosocial interventions tailored to their age. IMPLICATION TO PRACTICE: It underscores the complex nature of the psychosocial needs of children impacted by earthquakes and promotes collaborative efforts among healthcare professionals and nurses to provide more effective support to these children during challenging circumstances.

Communication, information, involvement and decision making: A systematic scoping review of child-parent-nurse relationships during postoperative pain management.

AIMS: To examine the existing literature on child-parent-nurse relationships (in relation to communication, information, and involvement and decision-making) during postoperative pain management. BACKGROUND: Pain in children is under-reported and under-treated in hospitals and research has continued to report high rates of pain among hospitalised children worldwide. The role of child-parent-nurse relationships may be a factor and to date, no review has been identified that focus on these relationships during postoperative pain management. DESIGN: A systematic scoping review following Arksey and O'Malley with further adaptations based on JBI. METHODS: A systematic search for published primary studies was conducted using the Medline, CINAHL, British Nursing Index, ASSIA, PsycINFO, Science Direct and Web of Science in English from 2000 to 2022. Two reviewers independently carried out data screening and extraction and any differences were resolved with the assistance of a third reviewer. The data were analysed using thematic analysis and presented descriptively. This study followed the PRISMA-ScR Checklist. RESULTS: A total of 37 studies met the inclusion criteria. The findings mainly demonstrated a focus on the perspectives of parents and nurses with less on children's perspectives and none of the studies explored child-nurse relationships. The findings were categorised under three themes: communication, information, and involvement and decision making. CONCLUSION: A prevailing deficiency in child-parent-nurse relationships significantly contributed to suboptimal postoperative pain care, causing prolonged and untreated postoperative pain in children. Children's hesitation in communicating with nurses, the limited communication skills of nurses, and the weak communication position of parents in a hospital setting all hindered the development of strong relationships between children, parents, and nurses. The unclear definition of the roles of children and parents in postoperative pain management resulted in confusion for both parents and nurses. This was exacerbated by parents' lack of knowledge and inadequate guidance from nurses, ultimately leading to a decreased level of parental involvement in their child's postoperative pain management while in the hospital. Unattended requests for pain management caused children to experience prolonged pain and led to a deterioration in the relationship between parents and nurses, as well as a reduction in the parents' ability to provide pain care to their child. RELEVANCE TO CLINICAL PRACTICE: This study highlights the reasons behind the suboptimal management of postoperative pain in children. The importance of the relationship between children, parents, and nurses in pain management must be acknowledged, and the results of this study may be used to inform improvements in nursing pain management practices. NO PATIENT OR PUBLIC CONTRIBUTION: Patient or public contribution is not a necessary stage in a systematic scoping review following Arksey and O'Malley's framework.

Interactions between children, parents and nurses during postoperative pain management: A grounded theory study.

AIM: To explore the interactions between children, parents and nurses during postoperative pain management. BACKGROUND: Despite the growing evidence relating to postoperative pain management in children and relevant practice guidelines, children still experience moderate to severe pain after surgery. One factor could be related to the relatively unexplored child-parent-nurse interaction. DESIGN: A qualitative constructivist grounded theory methodology. METHODS: Data were collected from a paediatric hospital in the United Kingdom. Ten children aged between 6 and 11 years old who had undergone surgery, 11 parents and 10 nurses participated. Methods included face-to-face semi-structured interviews. Data were analysed using constant comparison technique, memos and constructivist grounded theory coding levels. The COREQ guidelines were followed for reporting. FINDINGS: Three concepts emerged from data, "Parents as a communicator for child-nurse interaction", "Parents' emotional turmoil in child-nurse interaction", and "Parents' actions in child-nurse interaction" which constructed the substantive theory of child-parent-nurse interaction during postoperative pain management: "Facilitating or Inhibiting Interactions: Parental Influence on Postoperative Pain Management". The findings highlight an absence of a three-way interaction between children, parents and nurses and a dyadic interaction process between children and nurses was not apparent. Instead, child-parent-nurse interactions were constructed around two dyads of child-parent and parent-nurse interactions with child-nurse interaction constructed via parents. Parents, as a communicator, influenced the entire postoperative pain management processes between children, parents and nurses by facilitating or inhibiting the interaction processes. CONCLUSIONS: This study identifies potentially important evidence about the unique position parents hold between their child and nurses as a central pivotal communicator during children's postoperative pain management. RELEVANCE TO CLINICAL PRACTICES: This study may help to explain how and why postoperative pain management remains suboptimal. The substantive theory could support improvements in the management of postoperative pain through a much wider recognition of parents' central pivotal communicator role and the complexity of these child-nurse interactions.

Adolescents' experiences of fluctuating pain in musculoskeletal disorders: a qualitative systematic review and thematic synthesis.

BACKGROUND: Adolescents with chronic musculoskeletal pain experience daily fluctuations in pain. Although not all fluctuations are bothersome, pain flares are a distinct type of symptom fluctuation with greater impact. Since literature on the experience of pain flares is non-existent, the aim of this review was to (i) synthesise the qualitative literature on adolescents' experiences of fluctuating pain in musculoskeletal disorders in order to (ii) identify knowledge gaps to inform future research on pain flares. METHODS: Electronic databases (CINAHL, MEDLINE, EMBASE, PsycINFO), grey literature and reference lists were searched from inception to June 2018 for qualitative studies reporting adolescents' experiences of pain. Comprehensiveness of reporting was assessed using the Consolidated Criteria for Reporting Qualitative Health Research. Studies were analysed using thematic synthesis. RESULTS: Of the 3787 records identified, 32 studies (n = 536) were included. Principal findings were synthesised under three key themes: 1) symptom experience, 2) disruption and loss, and 3) regaining control. The first theme (symptom experience) describes adolescent's perception and interpretation of pain fluctuations. The second theme (disruption and loss) describes the physical, social and emotional constraints faced as a result of changes in pain. The third theme (regaining control) describes coping strategies used to resist and accommodate unpredictable phases of pain. Each theme was experienced differently depending on adolescents' characteristics such as their developmental status, pain condition, and the duration of the pain experience. CONCLUSIONS: Adolescents with chronic musculoskeletal pain live with a daily background level of symptoms which frequently fluctuate and are associated with functional and emotional difficulties. It was not clear whether these symptoms and challenges were experienced as part of 'typical' fluctuations in pain, or whether they reflect symptom exacerbations classified as 'flares'. Further research is needed to explore the frequency and characteristics of pain flares, and how they differ from their typical fluctuations in pain. The review also highlights areas relating to the pain experience, symptom management and health service provision that require further exploration to support more personalised, tailored care for adolescents with chronic musculoskeletal pain.