Exploring Parental Perceptions Regarding Surgical Pain Management Practices in a University Pediatric Inpatient Setting

Abstract

Background: Reports of inadequate pain assessment and management have resulted in the development of regulatory and professional standards and guidelines about pain management. However, there continues to be a high prevalence of pain in hospitalized children and continued evidence that parents perceive pain management to be suboptimal. Low parental satisfaction with pediatric pain management at a large academic medical center prompted the need for practice improvement. Although, identifying gaps in best pain practices are critical to reducing pain in hospitalized children, strategies to improve satisfaction must include understanding the perceptions and expectations of parents to improve organizational performance related to patient and family satisfaction.

Purpose: The objective of this capstone project was to explore parental perceptions regarding surgical pain management.

Design: A descriptive, non-experimental survey was used to interview parents of children with acute surgical pain management.

Sample: A convenience sample of 30 parents of post-surgical children admitted to the pediatric inpatient units at a large academic medical center was interviewed.

Methods: An assessment survey was developed for the purpose of this project and underwent content validation by a series of experts. Structured interview conducted up to 48 hours after surgery. A subset of parents (n=ll) whose child received patient-controlled analgesia (PCA) was re-interviewed after discontinuation.

Results: Post-operative pain occurred in 96.7% of the children, of whom one-half experienced moderate pain some or most of the time in the 24 hours prior to the interview. Eighty percent of the parental subset reported their child had pain some to most of the time after the PCA was discontinued. Although, 67% of the parents (n=20) were completely satisfied with the nurse's pain management at the first interview, 6 of these parents reported decreased satisfaction during the second interview. Parents of children whose post-operative pain was managed by the pain team were very satisfied with the early post-operative pain management; however, pain relief was perceived as less effective in the late post-operative period when managed by the surgical team. Forty percent of parents from both interviews identified earlier pain treatment, alternative pain treatment options and increased nursing availability as areas for improvement.

Implications: Parental perception of suboptimal pain control warrants improvements in pediatric pain management. The parental suggestions for improvement opportunities provide valuable information in designing QI strategies to optimize pediatric pain management unit practices. Findings also suggest the need for improved collaboration with the pain team during the first 24- hours after transition from PCA to around-the-clock analgesia. In addition, development of best practice pain protocols to standardize care for the pediatric surgical population may smooth transitions in pain management.