Children's tonsillectomy experiences: influencing factors.

The aim of this study was to explore factors influencing children's (7-13 years) tonsillectomy experiences and outcomes. A prospective, repeated measures, design was used to investigate the effect of age, gender, ethnicity, time, and previous pain, hospitalization and surgery on children's (N = 60) perceptions of anxiety, pain intensity, quality of pain and sleep, and oral intake. The relationship between postoperative pain and anxiety was also examined. Using a diary, three days of data were collected. Descriptive statistics, Pearson correlation coefficient, and a mixed linear regression model were used for analysis. Children's tonsillectomy experiences and outcomes were affected by time, previous experience, age, and anxiety. Moderate correlations were found between level of anxiety and pain intensity. These findings provide clinicians with additional knowledge to guide their perioperative practice and care of children.

Children's pre-operative tonsillectomy pain education: clinical outcomes.

OBJECTIVE: To examine the effects of pre-operative tonsillectomy pain education on children's (7-13 years) self-reported pre-operative anxiety and post-operative clinical outcomes (i.e., anxiety, pain intensity, quality of pain and sleep, oral intake, perceptions of pre-operative education, and pain expectation). METHOD: A prospective, repeated measures, quasi-experimental design using an age appropriate pain education booklet (n = 30) and a standard care comparison group (n = 30) was employed to investigate children's pre- and post-education anxiety and post-operative tonsillectomy with or without adenoidectomy subjective experiences in the hospital and home settings. Group comparisons were performed using the Wilcoxon test, Fisher's exact test, repeated measures analysis of variance, and mixed model regression. RESULTS: There were no significant differences between groups for measures of anxiety, pain intensity, quality of pain and sleep, oral intake, or expected pain. There was no change in anxiety before or after pre-operative education (P = 0.85). Ninety-six percent (n = 25) of the children in the intervention group reported that pre-operative pain education helped with their post-operative pain and 72% (n = 16) in the control group stated that it would be helpful to learn about pain before surgery. The majority of children in both the intervention and control groups (96%, 91%, respectively) stated learning about the 0-10 numeric pain intensity scale helped or would be helpful to learn pre-operatively. CONCLUSION: Pre-operative pain education did not affect anxiety. Children valued pre-operative pain education. Pre-operative pain education may influence children's perceptions of medical care.

A qualitative study of the barriers to chronic pain management in the ED.

PURPOSE: This qualitative study sought to identify perceived barriers to diagnosing and treating patients with chronic pain in the emergency department (ED). BASIC PROCEDURE: Semistructured interviews were conducted with 24 ED physicians from 4 hospitals to elucidate their experiences of managing chronic pain in the ED. MAIN FINDINGS: Time limitations and a low triage priority were major barriers to caring for patients with chronic pain. But despite the inherent problems of treating a nonurgent condition in a time-limited setting, physicians were strong proponents for treating chronic pain in the ED. PRINCIPAL CONCLUSION: Acknowledging that pain can neither be verified nor disproved, physicians tend to err on the side of the patient, often providing an allotment of opioid medications. They also believe that the ED is not an optimal setting for treating patients in chronic pain but that it is often the last resort for many of these patients, thus, providing the rationale for serving them to the best of their ability.

Adolescents' pain experiences following acute blunt traumatic injury: struggle for internal control.

ISSUES AND PURPOSE: Although blunt trauma injury is a common cause for adolescent pain, little is known about the experience of pain as perceived by adolescents. DESIGN AND METHOD: Semistructured interviews were conducted with 13 adolescents following blunt trauma injury. Two age-appropriate valid measures (i.e., Adolescent Pediatric Pain Tool and Temporal Dot Matrix) were incorporated into the interviews to elaborate their pain experiences. Grounded theory method was used to analyze data and build substantive theory. RESULTS: Adolescents' behavioral and cognitive actions (i.e., "internal control") to manage and endure pain were influenced by their pain perceptions, physical losses, and clinicians' actions. PRACTICE IMPLICATIONS: Nurses, family members, and peers have a crucial role in alleviating adolescents' distress and pain.

Initial validation of a numeric zero to ten scale to measure children's state anxiety.

BACKGROUND: Although children experience physical and behavioral consequences from anxiety in many health care settings, anxiety assessment and subsequent management is not often performed because of the lack of clinically useful subjective scales. Current state anxiety scales are either observational or multidimensional self-report measures requiring significant clinician and patient time. Because anxiety is subjective, in this pilot study, we evaluated the validity of a self-report numeric 0-10 anxiety scale that is easy to administer to children in the clinical setting. METHODS: A descriptive correlation research design was used to determine the concurrent validity for a numeric 0-10 anxiety scale with the state portion of the State-Trait Anxiety Inventory for Children (STAIC). During clinic preoperative visits, 60 children, 7-13 yr, provided anxiety scores for the 0-10 scale and the STAIC pre- and posteducation. Simple linear regression and Pearson correlation were performed to determine the strength of the relationship. RESULTS: STAIC was associated with the anxiety scale both preeducation (beta = 1.20, SE[beta] = 0.34, F[1,58] = 12.74, P = 0.0007) and posteducation (beta = 1.97, SE[beta]) = 0.31, F[1,58] = 40.11, P < 0.0001). Correlations were moderate for pre-education (r = 0.424) and posteducation (r = 0.639). CONCLUSIONS: This initial study supports the validity of the numeric 0-10 anxiety self-report scale to assess state anxiety in children as young as 7 yr.

Multidimensional assessment using the adolescent pediatric pain tool: a case report.

PURPOSE: Children's and adolescents' pain experiences are complex and multidimensional. Therefore, assessing a single dimension of pain intensity is in many instances inadequate. The purpose of this case report is to illustrate the benefits of using a multidimensional pain tool to assess vaso-occlusive pain in children and adolescents with sickle cell disease. CONCLUSIONS: The adolescent pediatric pain tool (APPT) provides a valid multidimensional pain assessment that facilitates individual pain assessments that optimize children's and adolescents' pain relief interventions and outcomes. PRACTICE IMPLICATIONS: The APPT is particularly valuable when clinicians encounter children and adolescents experiencing complex, difficult to manage pain.

The pain experience of adolescents after acute blunt traumatic injury.

Because little is known about adolescent pain, in particular pain after blunt traumatic injury, a descriptive exploratory approach was used to examine the pain experience of adolescents after acute blunt traumatic injury in three contexts: at the scene of the accident, in the emergency department, and in the hospital setting. For the 13 adolescents (11-17 years) who experienced multiple sites of blunt unintentional injury, the majority recalled their worst pain at the scene and in the emergency department, with high, intense pain persisting into the hospital setting. Regardless of the context, adolescents recalled multiple aspects of their pain experience. Study findings have implications for the understanding and management of adolescent pain resulting from blunt traumatic injury.