How nurses use reassurance to support the management of acute and chronic pain in children and young people: An exploratory, interpretative qualitative study.

Bernie Carter,Jane Harris,Abbie Jordan

doi:10.1002/pne2.12045

Bernie Carter, Jane Harris + Show 1 more

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https://doi.org/10.1002/pne2.12045

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Abstract

Reassurance in the context of pediatric pain is regarded to promote distress. Typically, spoken reassurance is reported as short, generic statements (“it's ok,” “don't worry”); little research has considered wider reassuring behaviors and actions undertaken by nurses. Most studies focus on unidirectional, dyadic relationships between reassurance and pain (parent‐to‐child, professional‐to‐child) failing to capture the inherent complexities. Adopting an exploratory, interpretative, and qualitative approach, this paper reports on findings from the qualitative interview component of a mixed‐methods study, concerning how nurses actively use reassurance when talking to children and their parents about pain. Eighteen nurses with experience of managing children's pain were recruited on completion of an international online survey (distributed by pain and children's nursing networks and via newsletter, email, and social media). All 18 nurses completed a semi‐structured interview concerning their experiences of managing children's pain working in the UK (n = 14), Canada (n = 3), and Australia (n = 1) in primary, secondary, and tertiary settings with nursing experience ranging from pre‐qualification to >20 years. Thematic analysis generated three themes which reflect the main ways in which nurses focus their reassurance within encounters with children and their parent(s): (a) on child and parent(s), (b) on the child, and (c) on the parent. Nurses generated reassurance using language, gesture, relationship building, individualizing approaches, education, and preparation. The study highlights the diversity of reassurance provided by nurses in relation to children's pain. Our study finds that when nurses reassure children about pain, they focus their reassurance in three distinct directions (child, parents, and children and parents in partnership); this has not been specifically acknowledged by previous research. We highlight the wide range of implicit and explicit reassurance actions undertaken by nurses and propose that reassurance that extends beyond limited vocalizations is part of a complex package of care that can support children's current and future pain experiences.

Highlights

Reassurance in the context of pediatric pain was precisely defined as a core code in the Child-Adult Medical Procedure Interaction Scale (CAMPIS) handbook as “procedure-related comments that are directed toward the child with the intent of reassuring the child about his/her conditions, or the course of the procedure”.1,2, p7 A more recent definition is “a procedure-related comment to child with the intent of neutralizing the situation or suggesting that the environment is nonthreatening”.3, p1123 Reassurance is widely regarded to promote child distress during experiences of pain.[1,3,4]
This study highlights the diversity in the nature of reassurance provided by nurses in relation to children's pain
The study illustrates that nurses' reassurance for children's pain is directed at the child, the parent and both the child and parent simultaneously

Summary

| INTRODUCTION

Reassurance in the context of pediatric pain was precisely defined as a core code in the Child-Adult Medical Procedure Interaction Scale (CAMPIS) handbook as “procedure-related comments that are directed toward the child with the intent of reassuring the child about his/her conditions, or the course of the procedure”.1,2, p7 A more recent definition is “a procedure-related comment to child with the intent of neutralizing the situation or suggesting that the environment is nonthreatening”.3, p1123 Reassurance is widely regarded to promote child distress during experiences of pain.[1,3,4] In painful procedures, reassuring comments by adults have been shown to precede child distress[1] and heighten child ratings of fear.[5]. The different qualities of the construct of reassurance have not yet been sufficiently explored in the pediatric literature.[11] In particular, little research has considered the range of behaviors and actions beyond these generic statements which are undertaken by nurses with the intention of reassuring children experiencing pain. This paper reports on findings concerning how nurses use reassurance when talking to children and their families about pain. These findings were generated from a subsidiary analysis of qualitative semi-structured interviews that were originally undertaken as part of a mixed-methods study which explored nurses' “pain talk” in the context of managing children's pain

| Design

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| DISCUSSION