Children’s views on postsurgical pain in recovery units in Norway: A qualitative study

Anja Hetland Smeland,Torgun Næss,Alison Twycross,Trond H. Diseth,Lill Nybro,Hanne Reinertsen,Tone Rustøen,Stefan Lundeberg

doi:10.1111/jocn.14788

Abstract

To explore children's postsurgical experiences with pain and pain management in the recovery unit. Children's pain is underestimated and undertreated. Untreated pain can cause unnecessary suffering, increased complication risks and may lead to chronic pain. Research exploring children's experiences with postoperative pain and pain management is limited. A qualitative, exploratory study. The study complied with the Consolidated Criteria for Reporting Qualitative Research (COREQ). Children (N=20), 8-16years old, took part in semi-structured interviews about their experiences with pain and postoperative pain management while they were in a recovery unit. Data were collected at two university hospitals in Norway. Content analysis was used to analyse the data. Three themes emerged from the interviews: "children's experiences of what felt unpleasant and painful," "children's experiences with pain management" and "children's recommendations for future pain management". About half of the children reported moderate to severe pain while in the recovery unit and they did not always tell their nurses when they had pain. They also reported experiencing pain in places other than their surgical wounds and stated that nausea and vomiting felt unpleasant and painful. The children indicated that pain medications and the use of nonpharmacological methods helped them cope with their pain and provided several recommendations about how to improve pain management. Paediatric postoperative pain management remains suboptimal. The children in our study provided useful information about their pain experiences, how to improve pain management and explained why they did not tell their nurses when they were in pain. These findings should direct further improvements in paediatric postoperative pain management, such as increased use of pain assessment tools and preparatory information, as well as more appropriate administration of pain medications.

Highlights

Children’s postoperative pain is underestimated and undertreated (Pope et al 2017, Sng et al 2017, Twycross et al 2015)
The children in our study provided useful information about their pain experiences, how to improve pain management and explained why they did not tell their nurses when they were in pain
Many of them did not tell their nurses when they were in pain and pain assessment tools do not appear to have been used routinely

Summary

Introduction

Children’s postoperative pain is underestimated and undertreated (Pope et al 2017, Sng et al 2017, Twycross et al 2015). Canada (Birnie et al 2014, Twycross & Finley 2013), Thailand (Thienthong et al 2014), Australia (Ford et al 2012), Singapore (Sng et al 2013), and Sweden (Rullander et al 2013) These studies all support the notion that children continue to experience moderate to severe pain postoperatively. Children have described a range of negative emotions including anger, fear, and sadness in relation to their experiences with postoperative pain (Ford et al 2012, Sng et al 2013, Twycross & Finley 2013). Children’s views about their postoperative pain management have been explored in some ee studies (Ford et al 2012, He et al 2007, Sng et al 2013, Twycross & Finley 2013). Children have recommended the use of more non-pharmacological pain management techniques, such as distraction and positioning (Sng et al 2013)

Methods

Results

Discussion

Conclusion