Changing healthcare provider and parent behaviors in the pediatric post-anesthesia-care-unit to reduce child pain: Nurse and parent training in postoperative stress.

Brooke N Jenkins,Mai Makhlouf,Paulina Lim,Remy Converse,Zeev N Kain,Robert Stevenson,Michelle A Fortier,Suellen Walker

doi:10.1111/pan.13649

Brooke N Jenkins, Mai Makhlouf + Show 6 more

Open Access

https://doi.org/10.1111/pan.13649

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Abstract

Children who undergo surgery experience significant pain in the post anesthesia care unit. Nurse and parent behaviors in the post anesthesia care unit directly impact child postoperative pain. Therefore, we have developed and evaluated (Phase 1) and then tested (Phase 2) the feasibility of a new intervention (Nurse and Parent Training in Postoperative Stress) to alter parent and nurse behaviors in a way consistent with reducing child postoperative pain. In Phase 1, a multidisciplinary team of experts (physicians, nurses, and psychologists) developed an empirically-based intervention which was then evaluated by experienced nurses (N=8) and parents (N=9) during focus groups. After revising the intervention based on focus group feedback, it was tested in Phase 2 using a pre-post study design. Nurses (N=23) who worked in the recovery room were recruited to be part of both pre- and post-intervention data collection periods. Parents were recruited to be part of either the pre- (N=52) or post-intervention (N=60) data collection periods. Nurses and parent-child dyads were recorded in the post anesthesia care unit and videos were coded for the desired (ie, behaviors that may decrease child pain) and non-desired (ie, behaviors that may increase child pain) behaviors. Pain data was collected from the children's medical records to assess pain after surgery. The intervention was given to the nurses and parents in the post-intervention data collection period. Nurses significantly increased their rate of desired behaviors by 231% (P=0.001; Somer's D=1) and significantly decreased their rate of non-desired behaviors by 62% (P=0.004, Somer's D=-0.88, 95% CI [-1.74, -0.03]). Parents significantly increased their rate of desired behaviors by 124% (P=0.033). Moreover, the intervention significantly decreased child pain in the post anesthesia care unit (b=-2.19, SE=0.63, z=-3.46, P=0.001, 95%CI [-3.43, -0.95]). The intervention was effective in changing nurse and parent behaviors as well as child pain after surgery.

Highlights

Over 85% of children who undergo surgery every year experience significant pain in the post anesthesia care unit (PACU)[1,2,3]
We first present the development and formative evaluation (Phase 1) of an empirically-based behavioral intervention (Nurse and Parent Training in Postoperative Stress [NP-TIPS]) to change the behavior of nurses and parents in the PACU to impact the multidimensional stressor of pain
There was a significant interaction between condition and time (b = 0.31, SE = 0.09, z = 3.65, p < .001, 95%CI [0.15, 0.48]) such that children in the post-intervention condition had low pain throughout their PACU stay while children in the pre-intervention group had higher pain during the beginning of their PACU stay. In this manuscript, we report the successful development, evaluation, and testing of an innovative postoperative intervention, NP-TIPS. This empirically-based intervention was directed at parent and nurse behaviors and subsequently child pain in the PACU

Summary

Introduction

Over 85% of children who undergo surgery every year experience significant pain in the post anesthesia care unit (PACU)[1,2,3]. Postoperative pain continues to be prevalent when children return home, with up to 70% of children and parents reporting immediate postoperative pain and up to 28% continuing to experience pain one week following surgery[4] This is of high clinical significance, as pain can result in a multitude of negative consequences; children in pain require increased analgesic consumption, experience delayed recovery from surgery[3], and often suffer from maladaptive behavioral changes including decreases in socialization, healthy eating habits, and sleep[3]. Previous work by our research group has demonstrated that nurse and parent verbal and nonverbal behaviors in the PACU influence children’s postoperative pain[6]. We first present the development and formative evaluation (Phase 1) of an empirically-based behavioral intervention (Nurse and Parent Training in Postoperative Stress [NP-TIPS]) to change the behavior of nurses and parents in the PACU to impact the multidimensional stressor of pain. We present the results of the efficacy of the intervention (Phase 2) in changing nurse and parent behaviors and subsequently child pain

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Discussion