Study On Parental Experience And Knowledge,Attitudes And Practices Regarding Children’s Postoperative Pain Management In Orthopedics

Objectives:To explore parental experience of involvement in children’s postoperative pain management in orthopedics through qualitative research.To further investigate parental knowledge,attitudes and practices(parents’ proxy-assessment of pain intensity and use of pain relief strategies)regarding children’s postoperative pain management and analyze the influencing factors through quantitative research.For providing theoretical reference for making clinical management specification and developing targeted educational programs.Methods:This study included two parts:1.Qualitative research:Using the phenomenon method of qualitative research,16 cases of parents with their children admitted to pediatric orthopedics and underwent selective surgeries in Children’s Hospital of Soochow University were conveniently selected from September to November in 2019 for face-to-face semi-structural in-depth interviews.And Colaizzi7 step method was used for data analysis.2.Quantitative research:The reliability of the Pain Management Knowledge and Attitudes-Questionnaire for parents(PMKA)and Parent’s Use of Pain Relief Strategies(PUPRS)was tested by a pre-survey.Using the purposive sampling method,200 children and their parents who met the inclusion and exclusion criteria were mainly selected in pediatric orthopedics of Children’s Hospital of Soochow University from August to December in 2020.A general information questionnaire,Wong-Baker Facial Pain Rating Scale(WBFP),PMKA,PUPRS and Simplified Coping Style Questionnaire were used to survey.Epidata3.1 conducted data entry,and SPSS23.0 software for statistical analysis.Results:1.Qualitative research:Three themes were identified:’parents’ practices of participating in children’s postoperative pain management were inadequately:over rely on children’s independent report,delayed report of pain,selective use of nonpharmacological strategies,exclusive use of pain medication’,‘complex factors influencing parent’s practices:their anticipation of children’s pain suffering,lack for knowledge,negative emotions,burden of care and social support and parent-child relationship’,’parents need support and professional related information’.2.Quantitative research:(1)195 cases of children and their parents were recruited.The average scores of parents’ knowledge,general attitude and negative attitude toward medication were(16.38±3.39),(25.70±3.54)and(15.97±3.86),with moderate levels accounting for 62.1%,57.4%and 62.1%respectively.(2)73.3%and 42.0%of parents reported(using WBFP Rating Scale)moderate to severe pain intensity of 1d and 2d after surgery and the Cohen’s Kappa coefficient with child’s self-report which ranged from 0.556 to 0.631 were all higher than child-nurse(Cohen’s Kappa coefficient were ranged from 0.318 to 0.319).(3)The mean score of PUPRS was(52.55±7.19),the median behavior level accounted for 63.1%.Parents more often used emotional support,assist in daily activities,distract attention and other nonpharmacological strategies.While the use of pain medication,heat and cold therapy,request medication,breathing technique were rarely used.(4)Pearson analysis showed a positive correlation between parents’use of pharmacological pain relief strategies and their knowledge,general attitude,proxy-assessment of pain intensity,positive response,while a negative correlation with negative attitude toward pain medication(P<0.01);There was a positive correlation between parents’ use of nonpharmacological pain relief strategies and their knowledge,general attitude,positive response,while a negative correlation with negative attitude toward medication(P<0.01);(5)The multilinear regression analysis showed that the family place of residence,the age of the children and the parent’s educational level were the factors that influence the parental knowledge and the general attitude,explaining the variance of 19.4%(R~2=0.194);Parent’s educational level,number of children and children’s surgical type were factors that influence parental negative attitude toward pain medication,explaining the variance of 13.1%(R~2=0.131);Parental knowledge,positive response,parent’s gender,monthly family income,self-surgical experience,the age of the children and lower extremity fracture were the factors that influence parents’ use of pain relief strategies,explaining the variance of 38.1%(R~2=0.381).Conclusion:1.Parental practices of involvement in children’s postoperative pain management in orthopedics are insufficient and are influenced by their status of knowledge,attitudes and family relationships,etcetera.They need support and related information from medical institutions and the medical personnel.2.Parents are at a moderate level of knowledge and the general attitude regarding children’s postoperative pain management,but there are still serious knowledge defects and negative attitudes regarding pain assessment tools and the use of pain medication.3.Although parents’ proxy-assessment of children’s postoperative pain intensity is better consistent with children’s self-report and their PUPRS is at a moderate level,they prefer to use more simple strategies,and barely use ’pain medication’ and some certain nonpharmacological pain relief strategies.4.PUPRS is influenced by children’s and their parents’ background factors,knowledge and positive response.Therefore,medical institutions and medical personnel should create a supportive environment,pay attention to the positive role of parents in assessment of pain intensity and corresponding interventions,make clinical management specification and develop targeted pain health educational programs,improve parental awareness,positive response and negative attitudes to promote their beneficial behaviors.