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INTRODUCTION:

Despite the availability of a variety of evidence-based interventions, it has previously been reported that the majority of infants and children undergo vaccine injections without the benefit of analgesia. Nurses in public health administer a substantial number of injections; however, their attitudes and practices surrounding acute pain during vaccine injections have not been previously explored.

METHODS:

A focus-group interview was conducted in Toronto, Ontario, with 10 nurses who immunize children. Participants reported their perceptions and practices with regard to vaccine injection pain and pain management.

RESULTS:

Three key themes emerged: environmental and process factors, perceptions regarding the effectiveness of different analgesic interventions, and perceptions regarding pain and fear. Participants reported a lack of control over their environment, resulting in fear and discomfort for children. They recommended increased support from external partners such as school teachers and administrators. Participants reported that pharmacological interventions, such as topical local anesthetics, were not used; however, psychological and physical interventions were commonly used. Nurses questioned the effectiveness of topical anesthetics, and indicated that more education was required regarding effective analgesic interventions. Needle pain was reported to be the most prominent concern for children undergoing vaccine injections, and children were described as being fearful.

DISCUSSION:

Nurses reported vaccination setting, analgesic effectiveness and relative importance given to pain as important factors for pain and pain management during vaccine injections. Future studies should explore whether additional perspectives are present in vaccinators in other geographical regions. The effectiveness of educational resources and pain management programs aimed at improving current practices should be investigated.

The present commentary calls for the implementation of evidence-based policies to manage paediatric needle pain in clinical settings. While there have been fundamental advances in the treatment of needle pain over the past three decades, relevant techniques are often not used in clinical practice. Evidence indicates that needle procedures do hurt, are frequently cited as the most painful experience by children and a subset of children are terrified of them. Pain and distress from needle procedures can and must be addressed because needle procedures are frequently performed on both healthy (eg, immunizations) and ill (eg, bone marrow aspirations, lumbar punctures) children. An essential step in translating research knowledge into practice is the creation of evidence-based policies. Policy statements regarding the management of needle pain must be incorporated at the hospital, clinic and individual office levels to reduce the amount of pain and distress children suffer from needle procedures. Specific suggestions for policies to be incorporated in clinical settings are provided.

Procedural pain is an important aspect of care in pediatrics, and particularly in pediatric oncology where children often consider this to be the most painful experience during their illness. Best recommended practice to control procedural pain includes both sedative-analgesic administration and non-pharmacological treatments, practiced in an adequate and pleasant setting by skilled staff. A nationwide survey has been conducted among the Italian Centers of Pediatric Hematology-Oncology to register operators' awareness on procedural pain, state of the art procedural pain management, operators' opinions about pain control in their center, and possible barriers impeding sedation-analgesia administration. Based on indications in the literature, we discuss the results of the survey to highlight critical issues and suggest future directions for improvement. Future objectives will be to overcome differences depending on size, improve operators' beliefs about the complexity of pain experience, and promote a global approach to procedural pain.

Objective

To observe pain management practices by nurses in emergency departments (EDs) in Central Africa and to study the various factors influencing these practices.

Methods

Time to first analgesic treatment was recorded in 53 patients presenting to the ED of a Central African hospital in February 2005. A survey was simultaneously conducted on the attitudes and commitment of nurses towards the management of pain. All 28 nurses assigned to the ED agreed to participate in the survey.

Results

Severity of pain was the factor most influencing the time to first analgesia following admission to the ED. Severe pain was assessed as a score of ⩾7 on a 1–10 visual analogue scale. The median time to first analgesia in patients with severe pain was 150 min, which was considerably longer than in patients without severe pain (p = 0.003). A quarter of the 28 nurses had no official training in pain management and most (>80%) were unable to carry out a formal assessment of pain. The majority (>90%) were confident of their ability to treat pain. Thirteen (48%) were of the opinion that cultural factors influenced their management of pain and 67% admitted that they had some fears about administering morphine to patients in the ED.

Conclusion

Pain management by nurses in the ED in Central Africa is inadequate. Cultural factors greatly influence how nurses manage pain in the emergency room. Patients would benefit considerably if nurses received additional education about the diagnosis and management of acute pain in EDs in Central Africa.

Researchers believe that cultural factors have important implications for infant pain expression and caregiver management strategies. Per capita, Canada accepts more immigrants than any other country. Thus, it is important to understand the impact of cultural identity on caregiver soothing behaviour and infant distress. The authors of this study aimed to explore the impact of maternal culture on the mother’s soothing behaviours and the level of distress expressed by the infant receiving an immunization injection. By assessing their level of acculturation and ensuring that the participants identified with both their self-reported heritage culture and mainstream North American culture, this study contributes to the pediatric pain literature by increasing our understanding of the nature of hypothesized social dimensions such as culture.

OBJECTIVE:

To investigate how maternal culture (ie, individualist versus collectivist) influences soothing techniques and infant distress.

METHODS:

Archival data were analyzed using a subsample of 80 mother-infant dyads selected from a larger database of infant pain expression.

RESULTS:

Mothers belonging to the individualist group used more affection behaviours when attempting to regulate their infants’ distress. No differences were observed in mothers’ touching, holding, rocking, vocalizing, caregiving or distracting their infants. Mothers’ culture did not appear to be related to the level of distress expressed by their infants.

CONCLUSIONS:

These results suggest that the similarities in soothing and infant pain expression between individualist and collectivist cultures are more prominent than their differences.

OBJECTIVE—To examine mothers' satisfaction with the process of immunisation and its possible contribution to suboptimal immunisation uptake.
DESIGN—In depth interviews with mothers.
SETTING—Two Community Care Areas, Dublin city, Ireland.
PARTICIPANTS—In depth interviews of 23 mothers of children 1-2 years old, recruited purposively from a birth cohort born in 1994.
MAIN RESULTS—Mothers preferred general practice to Health Centre immunisation (11:5) for predominantly emotional compared with practical reasons (4:1). Health Centre immunisation was seen, at times, as unacceptably rough and inhuman. Many mothers experienced severe emotional distress at the prospect of inflicting the pain of immunisation on their babies. The non-empathic stance of some immunising doctors was unacceptable to mothers. They valued attempts by health professionals to acknowledge the pain of immunisation and to engage with their baby. Adverse experiences contributed to deferral of future visits and to defaulting behaviour.
CONCLUSIONS—Low empathy mass immunisation in clinic type settings may be unacceptable to mothers in the 1990s, and may in part explain suboptimal uptake in health care systems that use such clinics.


Keywords: immunisation; health behaviour; immunisation uptake

Background

To explore the health beliefs, experiences, treatment and expectations of people with chronic knee pain, and investigate if, how and why these change after taking part on an integrated exercise-based rehabilitation programme - Enabling Self-management and Coping with Arthritis knee Pain through Exercise, ESCAPE-knee pain.

Methods

Semi-structured interviews were conducted with people with chronic knee pain, before (n = 29) and after (n = 23) participation on the programme. Thematic analysis was used to document people's baseline health beliefs, attitudes and cognitions, and to see if how and why these changed after completing the programme.

Results

Initially people had poor understanding and negative, fatalistic beliefs about the management or prognosis for knee pain. Following the programme the majority of participants had positive experiences describing improvement in pain, physical and psychosocial functioning, greater knowledge and understanding of their condition and treatment options, and in their ability to use exercise to control symptoms. Beliefs about the causation and prognosis of knee pain were unchanged, but their concerns about possible dangers of exercise had decreased, they appreciated how exercise could reduce symptoms (treatment beliefs) and their confidence in their ability to use exercise to effect improvements (exercise self-efficacy) increased. These improvements were attributed to the content and structure of the programme, and the care and guidance of the physiotherapist. Several expressed a need for on-going support.

Conclusions

ESCAPE-knee pain appears to achieve improvements by increasing people's treatment belief in safety and the utility of exercise to control symptoms, rather than alteration in their beliefs about causation or prognosis.

Trial Registration

Current Controlled Trials ISRCTN94658828

SYNOPSIS

Objective.

Low childhood immunization rates have been a challenge in Colorado, an issue that was exacerbated by a diphtheria-tetanus-acellular pertussis (DTaP) vaccine shortage that began in 2001. To combat this shortage, the locally based Tri-County Health Department conducted a study to assess immunization-related barriers among children in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), a population at risk for undervaccination.

Methods.

This study assessed characteristics and perceptions of WIC mothers in conjunction with their children's immunization status in four clinics.

Results.

Results indicated poor immunization rates, which improved with assessment and referral. The uninsured were at higher risk for undervaccination. DTaP was the most commonly missing vaccine, and discrepancies existed between the children's perceived and actual immunization status, particularly regarding DTaP. Targeted interventions were initiated as a result of this study.

Conclusion.

Local health departments should target immunization-related interventions by assessing their own WIC populations to identify unique vaccine-related deficiencies, misperceptions, and high-risk subpopulations.

One hundred and sixty-two children (57 boys and 105 girls), aged between three and 15 years and suffering from recurrent abdominal pain, were seen in general practice in Thamesmead during a seven-year period. Only five were found to have possible organic causes for the pain. Comparison with a control group showed that the close relatives of children with pain consulted doctors more often, had had more abdominal complaints and operations, a higher rate of psychiatric illness and referral, and more known marital problems. Relations between mothers and children with recurrent pain were often unstable and inconsistent. The clinical picture was unhelpful and investigation unproductive.

Recurrent abdominal pain in childhood is often a reflection of family disorder, and assessment of the state of the family should precede decisions on management.

Mothers of children who need reconstructive operations for defects present at birth are likely to feel guilty, particularly if the pregnancy was unwanted. The physician treating the child is in a position to reassure the mother and assuage her guilt.

To the child, the meaning of a surgical experience depends not on the type or seriousness of the actual operation, but on the type and depth of imaginings which it stimulates. For children between two and four, the anxiety of separation from the mother is greater than that aroused by the anesthetic. A good relationship with the mother will insulate the child against many traumatic events.

A surgical operation is an important and stressful experience for a child, activating the great childhood fears of abandonment, of mutilation, and of death. Very frequently, children with harelip and cleft palate, by the time definitive restorative surgery is contemplated, have had emotional experiences that make them more than usually vulnerable to the harmful effects of operation. If the child can discuss the products of his imagination about the operation and have them corrected by someone he trusts, the total response will be more adequate. Talking out and playing out help prevent the development of excessive and harmful emotional reactions.

Background

Pain is one of the most frequent and distressing symptoms in cancer patients. For the majority of the patients, sufficient pain relief can be obtained if adequate treatment is provided. However, pain remains often undertreated due to institutional, health care professional and patient related barriers. Patients self management skills are affected by the patients' knowledge, activities and attitude to pain management. This trial protocol is aimed to test the SCION-PAIN program, a multi modular structured intervention to improve self management in cancer patients with pain.

Methods

240 patients with diagnosed malignancy and pain > 3 days and average pain ≥ 3/10 will participate in a cluster randomized trial on 18 wards in 2 German university hospitals. Patients from the intervention wards will receive, additionally to standard pain treatment, the SCION-PAIN program consisting of 3 modules: pharmacologic pain management, nonpharmacologic pain management and discharge management. The intervention will be conducted by specially trained oncology nurses and includes components of patient education, skills training and counseling to improve self care regarding pain management beginning with admission followed by booster session every 3rd day and one follow up telephone counseling within 2 to 3 days after discharge. Patients in the control group will receive standard care.

Primary endpoint is the group difference in patient related barriers to management of cancer pain (BQII), 7 days after discharge. Secondary endpoints are: pain intensity & interference, adherence, coping and HRQoL.

Discussion

The study will determine if the acquired self management skills of the patients continue to be used after discharge from hospital. It is hypothesized that patients who receive the multi modular structured intervention will have less patient related barriers and a better self management of cancer pain.

Trial Registration

ClinicalTrials NCT00779597

Background

Chronic or recurrent non-malignant pain is a significant problem for many children and adolescents and often limits the child's participation in normal physical, academic, and social activities.

Objective

To better understand the impact of chronic or recurrent pain on children within the context of their own lives and experiences, using qualitative analysis, and to suggest the applications of the narrative method to clinical practice.

Design

Grounded theory and narrative analysis of in-depth semi-structured interviews conducted at baseline and 6-12 months following clinic intake.

Setting

Subject homes.

Patients

53 children ages 10-17 presenting with recurrent pain to a university-based pain clinic. This sample did not differ significantly from the overall clinic population during the study period.

Results

Five common themes were identified; these suggested that isolation, changed self-perception, activity limitations and concerns about barriers to future goals, and lack of medical validation were important to the children's perceived impact of pain on their lives. Five narratives were identified, each of which provided a coherent, integrated description of the factors and perspectives presented by a specific subset of children at baseline. These narratives were then compared against the children's reports of improvement in pain and functioning at 6-12 months; from this comparison, a sixth narrative of therapeutic change emerged for some of the children.

Concusions

The authors suggest that physicians and parents who take the initiative to elicit the child's narrative can help the child to rewrite the story to promote therapeutic change, a better outcome, and higher satisfaction.

Research in the field of pediatric pain has largely ignored the role of fathers in their children’s pain experiences. The first objective of the present study was to examine the effect of the presence of mothers versus fathers on children’s subjective ratings, facial expressions and physiological responses to acute pain. The second objective was to examine whether child and parent sex influence parents’ proxy ratings of their children’s pain. The final objective was to compare levels of agreement between mothers’ and fathers’ assessments of their children’s pain. Participants included 73 children (37 boys, 36 girls), four to 12 years of age, along with 32 fathers and 41 mothers. Children undertook the cold pressor pain task while observed by one of their parents. During the task, the children’s heart rates and facial expressions were recorded. Children provided self-reports and parents provided proxy reports of child pain intensity using the seven-point Faces Pain Scale. Neither child nor parent sex had a significant impact on children’s subjective reports, facial expressions or heart rates in response to acute pain. Fathers gave their sons higher pain ratings than their daughters, whereas mothers’ ratings of their sons’ and daughters’ pain did not differ. Kappa statistics and t tests revealed that fathers tended to be more accurate judges of their children’s pain than mothers. Overall, this research highlights the importance of examining both parent and child sex differences in pediatric pain research.

Background

The Advisory Committee on Immunization Practices advocates that influenza immunization is the most effective method for prevention of illness due to influenza. Recommendations for vaccination of children against influenza have been revised several times since 2002, and as of 2008 include all children 6 months to 18 years of age. Nevertheless, influenza immunization rates have remained low.

Methods

We surveyed practicing pediatricians in Maryland in the spring of 2007 to determine their attitudes and practices toward childhood influenza immunization.

Results

The overall response to the survey was 21%. A total of 61% of respondents reported that immunization either is cost neutral or produces a loss, and 36.6% noted it was minimally profitable. Eighty-six percent of respondents were receptive to supporting school-based immunization programs, and 61% indicated that they would participate in such programs. Respondents reported higher rates of immunization of select patient groups than those noted by the Centers for Disease Control and Prevention

Conclusion

Vaccination was reported to occur at multiple types of patient encounters, as recommended. Survey respondents stated that practice-based immunization was not a profitable service. Pediatricians were supportive of school-based immunization programs, and more than half stated they would be actively involved in such programs. School-based programs may be critical to achieving high vaccination coverage in the school-aged population.

Background

Beliefs of caregivers about patient's pain have been shown to influence assessment and treatment of children's pain, now considered an essential part of cancer treatment. Painful procedures in hematology-oncology are frequently referred by children as the most painful experiences during illness. Aim of this study was to evaluate professionals' beliefs about painfulness of invasive procedures repeatedly performed in Pediatric Hemato-Oncology Units.

Methods

Physicians, nurses, psychologists and directors working in Hemato-Oncology Units of the Italian Association of Pediatric Hematology-Oncology (AIEOP) were involved in a wide-nation survey. The survey was based on an anonymous questionnaire investigating beliefs of operators about painfulness of invasive procedures (lumbar puncture, bone marrow aspirate and bone marrow biopsy) and level of pain management.

Results

Twenty-four directors, 120 physicians, 248 nurses and 22 psychologists responded to the questionnaire. The score assigned to the procedural pain on a 0-10 scale was higher than 5 in 77% of the operators for lumbar puncture, 97.5% for bone marrow aspiration, and 99.5% for bone marrow biopsy. The scores assigned by nurses differed statistically from those of the physicians and directors for the pain caused by lumbar puncture and bone marrow aspiration. Measures adopted for procedural pain control were generally considered good.

Conclusions

Invasive diagnostic-therapeutic procedures performed in Italian Pediatric Hemato-Oncology Units are considered painful by all the caregivers involved. Pain management is generally considered good. Aprioristically opinions about pain depend on invasiveness of the procedure and on the professional role.

Background

Chronic non-cancer pain is an increasing problem in health care. This study was initiated by a patient wanting to discover more about the experiences of other patients requiring strong opioid analgesia for such pain.

Aim

To determine the attitudes and experiences of patients receiving long-term strong opioid medication for chronic non-cancer pain in primary care.

Design of study

Qualitative study using interpretative phenomenological analysis.

Setting

A semi-rural general practice in southwest England.

Method

The study data came from a focus group and 10 individual patient interviews. A patient researcher was involved in the design, conduct, and analysis of the project.

Results

The impact of pain affected participants in every aspect of their daily lives. Attitudes to strong opioid medication were both positive and negative. Concerns about starting medication usually centred on fears of addiction, being seen as an addict, or that the patients may have a more serious condition than they had previously thought. However, these fears were tempered by an appreciation of the benefits that strong opioids brought in terms of pain relief and consequent gains in a nearer-to-normal existence. The data did not produce any evidence of addictive behaviour or of tolerance despite these initial fears. Patients adopted a trade off approach, balancing pain relief with medication side effects, accepting more pain for a reduction in sedation and nausea. All patients described coping strategies they developed themselves and learned from outside influences, such as pain clinic courses and support from the GP. There was realism that total pain relief was not possible, but that a balance could be struck.

Conclusion

Chronic non-cancer pain is associated with high levels of distress and psychosocial impairment. Patients in this study appreciated the benefits of strong opioid medication, having come to terms with fears of addiction and learned coping strategies. These findings should encourage GPs to consider strong opioid medication for patients with severe chronic pain in line with published evidence-based guidelines.

Background

The use of opioid medications as treatment for chronic non-cancer pain remains controversial. Little information is currently available regarding healthcare providers' attitudes and beliefs about this practice among older adults. This study aimed to describe primary care providers' experiences and attitudes towards, as well as perceived barriers and facilitators to prescribing opioids as a treatment for chronic pain among older adults.

Methods

Six focus groups were conducted with a total of 23 physicians and three nurse practitioners from two academically affiliated primary care practices and three community health centers located in New York City. Focus groups were audiotape recorded and transcribed. The data were analyzed using directed content analysis; NVivo software was used to assist in the quantification of identified themes.

Results

Most participants (96%) employed opioids as therapy for some of their older patients with chronic pain, although not as first-line therapy. Providers cited multiple barriers, including fear of causing harm, the subjectivity of pain, lack of education, problems converting between opioids, and stigma. New barriers included patient/family member reluctance to try an opioid and concerns about opioid abuse by family members/caregivers. Studies confirming treatment benefit, validated tools for assessing risk and/or dosing for comorbidities, improved conversion methods, patient education, and peer support could facilitate opioid prescribing. Participants voiced greater comfort using opioids in the setting of delivering palliative or hospice care versus care of patients with chronic pain, and expressed substantial frustration managing chronic pain.

Conclusions

Providers perceive multiple barriers to prescribing opioids to older adults with chronic pain, and use these medications cautiously. Establishing the long-term safety and efficacy of these medications, generating improved prescribing methods, and implementing provider and patient educational interventions could help to improve the management of chronic pain in later life.

Pain expression in both pre-term and term infants is a little understood phenomenon. Recent research has generated data documenting that the newborn can feel pain, can act to avoid the pain, and may form memory traces of the experience. ”Nociceptive activity” or ”noxious stimuli” are better terms to use when addressing aversive stimulation of the neonate because they encourage scrutiny of the behavioural and physiologic responses of the newborn without placing emphasis on the emotional and subjective associations of the word ”pain”. Many invasive procedures are performed on infants with little or no provision for adequate pain management. The general and specific responses of the neonate to pain must be recognized. Analgesia and anesthesia should be made available to all infants, pre-term or term, sick or well, on the same basis on which they are made available to older children and adults.

Not considering cancer patients’ own views and experience with pain, especially gender and ethnic differences in their cancer pain experience, was reported to be a major contributor to the miscommunication that frequently results in inadequate cancer pain management. The purpose of this study was to explore white cancer patients’ perception of gender and ethnic differences in pain experience through an online forum. This was a descriptive qualitative study among 29 white cancer patients based on a feminist approach. Nine topics related to cancer pain experience were used. The data were analyzed using thematic analysis: 5 themes were identified. First, the participants perceived that pain accompanies cancer throughout the diagnosis and treatment process. Second, the specific characteristics of the participants’ individual culture and its view of pain and cancer could result in different cancer pain experience even among white cancer patients. Third, the participants complained that women’s pain was not taken seriously by health care providers. Fourth, the participants reported highly individualized pain experience with emotional pain. Finally, the participants wanted to have a control of their own pain management process. Based on the findings, implications for nursing research and practice are proposed.

Purpose

To explore parents' experiences during the admission of their children to a pediatric intensive care unit (PICU).

Method

Qualitative method using in-depth interviews. Thematic analysis was applied to capture parents’ experiences. Thirty-nine mothers and 25 fathers of 41 children admitted to seven of the eight PICUs in university medical centers in The Netherlands were interviewed.

Results

Parents were interviewed within 1 month after their child’s discharge from a PICU. Thematic analysis identified 1,514 quotations that were coded into 63 subthemes. The subthemes were categorized into six major themes: attitude of the professionals; coordination of care; emotional intensity; information management; environmental factors; parent participation. Most themes had an overarching relationship representing the array of experiences encountered by parents when their child was staying in a PICU. The theme of emotional intensity was in particular associated with all the other themes.

Conclusions

The findings provided a range of themes and subthemes describing the complexity of the parental experiences of a PICU admission. The subthemes present a systematic and thematic basis for the development of a quantitative instrument to measure parental experiences and satisfaction with care. The findings of this study have important clinical implications related to the deeper understanding of parental experiences and improving family-centered care.

Electronic supplementary material

The online version of this article (doi:10.1007/s00134-010-2074-3) contains supplementary material, which is available to authorized users.

Background

Research indicates that work modifications can reduce sickness absence and work disability due to low back pain. However, there are few studies that have described modified work from the perspective of patients. A greater understanding of their experiences may inform future workplace management of employees with this condition.

Methods

Individual semi-structured interviews were conducted with twenty-five employed patients who had been referred for back pain rehabilitation. All had expressed concern about their ability to work due to low back pain. Data was analysed thematically.

Results

Many participants had made their own work modifications, which were guided by the extent of control they had over their hours and duties, colleague support, and their own beliefs and attitudes about working with back pain. A minority of the participants had received advice or support with work modifications through occupational health. Access to these services was limited and usually followed lengthy sickness absence. Implementation largely rested with the manager and over-cautious approaches were common.

Conclusions

There was little evidence of compliance with occupational health guidance on modified work. There appears to be insufficient expertise among managers and occupational health in modifying work for employees with low back pain and little indication of joint planning. On the whole, workers make their own modifications, or arrange them informally with their manager and colleagues, but remain concerned about working with back pain. More effective and appropriate application of modifications may increase employees' confidence in their ability to work.

Infants, including newborn babies, experience pain similarly and probably more intensely than older children and adults. They are also at risk of adverse long term effects on behaviour and development, through inadequate attention towards pain relief in early life. However, the issue of analgesia in young babies has been largely neglected in most clinical settings, despite subjecting them to painful diagnostic and therapeutic procedures. Several therapeutic and preventive strategies, including systemic and local pharmacological and non-pharamacological interventions, are reported to be effective in relieving pain in infants. A judicious application of these interventions, backed by awareness and sensitivity to pain perception, on the part of the caregivers is likely to yield the best results. This article is a review of the mechanisms of pain perception, objective assessment, and management strategies of pain in infants.

Pain is the most common reason people visit emergency rooms. Pain does not discriminate on the basis of gender, race or age. The state of pain management in the emergency department (ED) is disturbing. ED physicians often do not provide adequate analgesia to their patients, do not meet patients’ expectations in treating their pain, and struggle to change their practice regarding analgesia. A review of multiple publications has identified the following causes of poor management of painful conditions in the ED: failure to acknowledge pain, failure to assess initial pain, failure to have pain management guidelines in ED, failure to document pain and to assess treatment adequacy, and failure to meet patient’s expectations. The barriers that preclude emergency physicians from proper pain management include ethnic and racial bias, gender bias, age bias, inadequate knowledge and formal training in acute pain management, opiophobia, the ED, and the ED culture. ED physicians must realize that pain is a true emergency and treat it as such.

BACKGROUND:

Research suggests that caregivers’ beliefs pertaining to infant pain and which infant pain cues are perceived to be important play an integral role in pediatric pain assessment and management.

OBJECTIVES:

Following a recent quasi-experimental study reporting on caregiver background and age differences in actual infant pain judgments, the present study clarified these findings by analyzing caregivers’ pain beliefs and the cues they use to make pain assessments, and by examining how the wording of belief questions influenced caregivers’ responses.

METHODS:

After making pain judgments based on video footage of infants between two and 18 months of age receiving immunizations, parents, nurses and pediatricians were required to respond to questionnaires regarding pain beliefs and importance of cues.

RESULTS:

Parents generally differed from pediatricians. Parents tended to have less optimal beliefs regarding medicating the youngest infants, were more influenced by question wording, and reported using many more cues when judging older infants than other caregiver groups. In terms of beliefs, influence of question wording and cue use, nurses tended to fall in between both groups; they displayed similarities to both parents and pediatricians.

CONCLUSIONS:

Paralleling the original findings on pain judgments, these findings suggest that parents differ from pediatricians in their pain beliefs and the cues they use to make pain judgments. Moreover, some similarities were found between parents and nurses, and between nurses and pediatricians. Finally, caution must be taken when interpreting research pertaining to beliefs about infant pain because question wording appears to influence interpretation.

Background

Although numerous evidence-based and feasible interventions are available to treat pain from childhood vaccine injections, evidence indicates that children are not benefitting from this knowledge. Unrelieved vaccination pain puts children at risk for significant long-term harms including the development of needle fears and subsequent health care avoidance behaviours. Parents report that while they want to mitigate vaccination pain in their children, they lack knowledge about how to do so. An evidence-based clinical practice guideline for managing vaccination pain was recently developed in order to address this knowledge-to-care gap. Educational tools (pamphlet and video) for parents were included to facilitate knowledge transfer at the point of care. The objectives of this study were to evaluate usability and effectiveness in terms of knowledge acquisition from the pamphlet and video in parents of newly born infants.

Methods

Mixed methods design. Following heuristic usability evaluation of the pamphlet and video, parents of newborn infants reviewed revised versions of both tools and participated in individual and group interviews and individual knowledge testing. The knowledge test comprised of 10 true/false questions about the effectiveness of various pain management interventions, and was administered at three time points: at baseline, after review of the pamphlet, and after review of the video.

Results

Three overarching themes were identified from the interviews regarding usability of these educational tools: receptivity to learning, accessibility to information, and validity of information. Parents’ performance on the knowledge test improved (p≤0.001) from the baseline phase to after review of the pamphlet, and again from the pamphlet review phase to after review of the video.

Conclusions

Using a robust testing process, we demonstrated usability and conceptual knowledge acquisition from a parent-directed educational pamphlet and video about management of vaccination pain. Future studies are planned to determine the impact of these educational tools when introduced in clinical settings on parent behaviors during infant vaccinations.