Parents' experiences managing their child's complicated postoperative recovery.

Tonsillectomy is commonly performed as same-day surgery and parents are heavily relied upon for management of children's postoperative recovery. The objective of this study was to provide an in-depth description of the experiences parents face when managing their child's complicated postoperative recoveries at home. An exploratory qualitative study at an academic pediatric hospital in Eastern Canada was performed. Participants included 12 parents of children aged 3-6 years who underwent adeno/tonsillectomy and experienced unexpected outcomes or complications during the postoperative recovery period. Parents participated in semi-structured interviews within 6 months of their child's surgery. Interviews were transcribed verbatim and thematic analysis was used to identify themes in the parents' experiences. Parents described struggling to make the decision to come back to hospital, that adequate information does not prevent emotional difficulties, and feeling somewhat responsible for the unexpected outcome or complicated course of recovery. Communication with healthcare providers was considered very important in helping with the recovery process. This research helps to inform healthcare professionals about how they might better support families during complicated recovery processes. Areas of action may include clear communication, setting expectations, and psychosocial support.

Purcell M ，Longard J ，Chorney J ，Hong P ... -  《-》

Parents' experiences of managing their child's postoperative pain at home: an exploratory qualitative study.

To understand parents' experiences of managing their child's postoperative pain at home. Recent changes in children's health care services often shift the responsibility of managing children's postoperative pain to parents. Although pain management is important for good postoperative outcomes, it can be a challenging task for families, and children's pain is often under-managed. This qualitative study used semi-structured interviews to explore parents' experiences of managing their child's postoperative pain at home. Participants were parents of 10 typically developing 5- and 6-year olds, who underwent (adeno)tonsillectomy, and experienced no complications leading to hospitalisation in the postoperative period. One-on-one interviews were conducted with parents within three months of their child's surgery. Interviews were transcribed verbatim and content analysis was used to identify themes in parents' experiences. All children experienced some postoperative pain. Parents' experiences of managing their child's pain were impacted by balancing the pros and cons of administering analgesic medications, managing the emotional and psychological effects of their child's pain, as well as parents' information needs. Most parents' information needs were met yet they still struggled to manage their child's pain. These findings provide insight into some of the barriers that make this process challenging for many families, and what health care centres can do to help support parents manage their child's postoperative pain at home. The results of this study may aid in the design of interventions that will support parents when managing their child's postoperative pain at home and thus improve children's experiences.

Longard J ，Twycross A ，Williams AM ，Hong P ，Chorney J ... -  《-》

An exploration of Singaporean parental experiences in managing school-aged children's postoperative pain: a descriptive qualitative approach.

To enhance understanding of the experience of parents in managing their children's postoperative pain in Singapore. Parents play a significant role in their hospitalised child's postoperative pain care. Their active involvement may contribute to accurate pain assessment and effective pain management for their child. However, there is a lack of in-depth research exploring the experience of parents involved in their children's postoperative pain management. This study adopted a descriptive qualitative approach, which is situated in the interpretive paradigm. Semi-structured interviews were conducted to collect data from 14 parents whose children were hospitalised in one of the three paediatric surgical wards in a hospital in Singapore in December 2009. Thematic analysis was used to analyse the data. Three themes were identified: 'Actions used by parents to alleviate their child's postoperative pain', 'Factors influencing parents' management of their child's postoperative pain' and 'Parents' needs in the process of caring for their child's postoperative pain'. Parents used a range of non-pharmacological pain relief interventions for their child. Parental roles and expectations, bond between parent and child, support from nurses, family and own religious beliefs, as well as children's age and maturity level were factors which promoted parental participation, whereas parents' negative feelings, knowledge deficit and nurses' busy schedule were hindering factors. Parents expressed needs for more involvement in their child's care, adequate rest and information support from nurses. This study highlights the importance of involving parents in their child's postoperative pain management. It provides evidence for health care professionals to pay attention to factors that may influence parental participation and, therefore, guide their practice. Nurses need to provide parents with support and education to facilitate their roles and improve their child's postoperative pain management.

Lim SH ，Mackey S ，Liam JL ，He HG ... -  《-》

Children and their parents' assessment of postoperative surgical pain: Agree or disagree?

The purpose of this study is to compare postoperative pain scores between children undergoing tonsillectomy and adenoidectomy (T&A) surgery and their parents, identify potential predictors for this disagreement, and determine possible impact on analgesic administration. This is a prospective longitudinal study conducted with children undergoing outpatient T&A in 4 major tertiary hospitals and their parents. Children and their parents were enrolled prior to surgery and completed baseline psychological instruments assessing parental anxiety (STAI), parental coping style (MBSS), child temperament (EAS) and parental medication administration attitude questionnaire (MAQ). Postoperatively, parents and children completed at-home pain severity ratings (Faces Pain Scale-Revised, children; Numeric Rating Scale, parents) on postoperative recovery days 1, 2, and 3, reflecting an overall pain level for the past 24 h. Parents also completed a log of analgesic administration. Based on postoperative pain scores, parent-child dyads were classified as overestimators (i.e., parents rated their child's pain higher than children rated their own pain), in agreement (i.e., rating in agreement), or underestimators (i.e., parents rated their child's pain lower than children rated their own pain). A significant proportion of parent-child pairs disagreed on pain ratings on postoperative days 1-3 (30.05%-35.95%). Of those pairs in disagreement, the majority of parents overestimated their child's pain on all three postoperative days, specifically such that a total of 24-26% parents overestimated their child's pain on postoperative days 1, 2, and 3. Repeated measures ANOVA demonstrated that parents in the overestimator group administered higher, though still within safe limits, amounts of ibuprofen and oxycodone (mg/day) than did the underestimator or agreement groups. Multiple regression models showed hospital site as the only independent predictor for postoperative pain rating disagreement between children and parents. Since parents overestimate their child's postoperative pain and may administer more analgesics to their child, it is essential to develop a standardized method of child pain assessment and a tailored recommended postoperative analgesic regimen amongst medical providers for children undergoing T&A.

Kaminsky O ，Fortier MA ，Jenkins BN ，Stevenson RS ，Gold JI ，Zuk J ，Golianu B ，Kaplan SH ，Kain ZN ... -  《-》

Postoperative pain, nausea and vomiting following adeno-tonsillectomy - a long-term follow-up.

Adenotonsillectomy is a common pediatric surgical procedure. Our knowledge of the recovery profile, parental understanding, and expectations is limited. We aimed to assess the incidence of pain, nausea, and vomiting in children undergoing adenotonsillectomy on postoperative day 3 and 7. We also wished to evaluate parental understanding regarding discharge instructions as well as parental expectations and experience of their child's recovery. We enrolled 100 children (0-16 years) undergoing elective adenotonsillectomy. On day 3 and 7, parents were questioned about their child's level of pain, nausea/vomiting and their understanding regarding postoperative instructions. Hundred children (median, 6.68 years) were recruited. 52% of parents rated their child's pain as VAS ≥ 5 on day 3, dropping to 30% by day 7. Almost 33% of patients experienced nausea on day 3, dropping to 11.6% by day 7. A similar trend was observed for postoperative vomiting. Most parents, 89%, agreed that postoperative instructions were clear. However, knowledge regarding when to seek emergency medical advice was found to be lacking. On day 7, only 44% of parents reported that their child's recovery met their expectations. Adenotonsillectomy is associated with significant pain and PONV, persisting into the seventh postoperative day. Parental education and information seems inadequate and needs to be improved.

Stanko D ，Bergesio R ，Davies K ，Hegarty M ，von Ungern-Sternberg BS ... -  《-》