Dynamics on the field: a focused study on the culture and context of pediatric pain management at four Ghanaian hospitals

Abigail Kusi Amponsah,Victoria Bam,Anna Axelin,Collins Kwadwo Ahoto,Joana Kyei-Dompim,Evans Oduro

doi:10.1186/s12887-020-02399-w

Abigail Kusi Amponsah, Victoria Bam + Show 4 more

Open Access

https://doi.org/10.1186/s12887-020-02399-w

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Abstract

BackgroundAs part of efforts to develop and implement a short course educational program on pediatric pain management, the current study sought to understand the culture and contextual factors that influence children’s pain management in order to improve the practice in pediatric care settings.MethodsGuided by Bourdieu’s theory of practice, a focused ethnographic study was conducted from October, 2018 to February, 2019. The study was contextualized at four Ghanaian hospitals among purposefully sampled nurses, physicians, hospitalized children and their families. During the 20-week study period, three ethnographers spent 144 h conducting participant-observation sessions. Formal and informal interviews were held with participants in addition to review of hospital records.ResultsAnalysis of the field data resulted in four themes. “Children’s pain expression and response of caregivers” described the disposition (habitus) of both children and caregivers to act in particular ways due to children’s incomplete health status (bodily capital) which caused them pain and also resulted in discomforting procedures. “Pharmacological pain management practices and attitudes” elucidated the use of analgesics as the mainstay disposition (habitus) in children’s pain management due to high level of respect (symbolic capital) given to such interventions on the pediatric units (field). “Managing pain without drugs” illustrated healthcare providers and family caregivers’ disposition (habitus) of using diverse nonpharmacological methods in managing children’s pain. “Communication and interaction between pain actors” depicted how children’s access to care givers (social capital) can serve as a powerful tool in influencing pediatric pain assessment and management disposition (habitus) on the pediatric units (field).ConclusionsThe habitus of pediatric pain actors toward pain assessment and management practices are influenced by various forms of capital (social, cultural, symbolic, bodily and economic) operating at different levels on the pediatric care field. Quality improvement programs that seek to enhance pediatric pain management should use the insights obtained in this study to guide the development, implementation and evaluation stages.

Highlights

As part of efforts to develop and implement a short course educational program on pediatric pain management, the current study sought to understand the culture and contextual factors that influence children’s pain management in order to improve the practice in pediatric care settings
This approach was chosen as the researchers intended to understand the processes involved in the assessment and management of children’s pain within the pediatric care settings of four Ghanaian hospitals through the use of three foundational concepts
Our findings revealed that the habitus of the pediatric pain actors toward pain assessment and management practices were influenced by various forms of capital operating at different levels on the pediatric care field

Summary

Introduction

As part of efforts to develop and implement a short course educational program on pediatric pain management, the current study sought to understand the culture and contextual factors that influence children’s pain management in order to improve the practice in pediatric care settings. Treated pain can lead to both short-term and long-term biopsychosocial consequences on affected children. These include: activation of the stress response [6], impaired functional ability [7], delayed recovery, prolonged hospitalization, increased cost of healthcare [8], absence from school [9], post-traumatic stress [10], isolation [11], chronic pain and negative impact on children’s quality of life [12]. In order to prevent the numerous associated effects of undertreated pain, the American Academy of Pediatrics advocates for the expansion of pediatric pain assessment and management knowledge among healthcare providers [16]

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Conclusion