Procedural pain in children: A qualitative study of caregiver experiences and information needs

• Author / Creator

  Shave, Kassi DR

• Background: Procedural pain is the unpleasant sensory and emotional experience children endure when undergoing a medically situated intervention that may cause pain, anxiety, or distress. Procedural pain is a major contributor to every child’s experience with acute pain. Poorly managed procedural pain can have short-term and long-term impacts for a child, which can extend and complicate both the procedure and the emergency department (ED) stay. There are many evidence-based physical, pharmacological, and psychological interventions available to manage pain and distress in children undergoing procedures; however, they are under-utilized across Canadian EDs. Knowledge translation (KT) tools are essential to ensure the uptake of evidence in practice. The objective of this study was to actively collaborate with caregivers of children experiencing procedural pain in the ED, and gather information to inform the development of a novel, caregiver-focused KT tool for management strategies for procedural pain. Methods: Qualitative semi-structured interviews were conducted with a purposeful sample of caregivers of children who attended the ED at the Stollery Children’s Hospital. Our target for this study was children who underwent IV placement or venipuncture within 4 hours prior to the interview. Caregivers of children ages 3 to 12 years were included. Based on previous qualitative research, we anticipated approximately 10-15 interviews would be required to see saturation of the data. Questions moved from general to specific, with interviews later in the data collection period becoming increasingly focused. The interviews were audio-recorded and transcribed verbatim. Data analysis was facilitated through the use of NVivo 10. The key stakeholder for this research project was Translating Emergency Knowledge for Kids (TREKK), a National Centre of Excellence in Knowledge Mobilization. TREKK has a parent advisory group that provides input on all TREKK activities, and was involved in and provided feedback throughout the study. Results: Caregivers (n=12) were interviewed in the ED at the Stollery Children’s Hospital. Interviews were conducted within four hours of the child having an IV or venipuncture procedure, and the mean length of interview was 18 minutes. On average, caregivers were caucasian (n=11) mothers (n=9) between the ages of 30-41 (n=11) who were married (n=9), had received a post-secondary education, and reported a household income of >$90,000 per annum. The children of participants in our study were, on average, 7 years old, had an intravenous insertion procedure, and had a history of a chronic medical condition, as described by their caregiver. Analysis of the interviews revealed five major themes: 1) source of healthcare information; 2) delivering healthcare information; 3) communicating with caregivers; 4) procedure-related anxiety and long-term effects; and 5) advice from caregivers. Caregivers expressed that they want to receive information from their healthcare provider, and want the information to be directed at their child. Caregivers recommended the following methods for sharing healthcare information with children: treating children as someone who is going to understand, ensuring children know what to expect, describing the procedure using language and concepts that are familiar to children, giving children processing time, and involving children in the procedure. Caregivers wanted to be empowered to ask informed questions of their healthcare providers. Finally, caregivers in our sample consistently negative experiences with intravenous insertion and venipuncture procedures for their children, occurring mainly at urban and rural non-pediatric centres. Conclusions: Given that 85% of Canadian children in need of emergency care are see in non-pediatric EDs, our study supports the need for KT efforts targeting the general ED setting. This research generated key knowledge through collaborative researcher-stakeholder partnerships, and will form the foundation for the development of a KT tool that may empower patients and their caregivers to play an active role in their healthcare. Ensuring patient and caregiver access to essential health information is critical for enhanced, family-centered, healthcare delivery and improved child health outcomes.

• Subjects / Keywords

  • Knowledge translation
  • Pediatrics
  • Procedural pain
  • Emergency medicine

• Graduation date

  Fall 2016

• Type of Item

  Thesis

• Degree

  Master of Science

• DOI

  https://doi.org/10.7939/R3X05XJ2F

• License

  This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.