Experiences of Teaching and Learning Pediatric Pain Management in Ghana.

BACKGROUND: The literature has revealed gaps in knowledge and attitudes regarding pediatric pain management among Ghanaian nurses and nursing students that can be attributed to inadequate education in the area. Consequently, nursing tutors teaching pain management might not have the appropriate knowledge to transfer to their students. PURPOSE: To explore nursing tutors' experiences of teaching pediatric pain management as well as their students' learning experiences before and after the tutors' training workshop. DESIGN: A descriptive qualitative design was employed for the conduct of the study. METHODS: Data were collected via focus groups from 32 tutors and 24 students before and after an educational workshop. Data analysis drew on Braun and Clarke's thematic analysis. FINDINGS: Pre-workshop themes revealed knowledge deficits regarding pediatric pain management in both tutors and students due to learning having occurred in bits and pieces. Furthermore, lack of accessibility to books and pain scales perpetuated this bits-and-pieces approach to learning. Post-workshop findings revealed gains in tutors' knowledge and skills. Consequently, students gained new insights into pediatric pain management. CONCLUSION: Tutors and student nurses had a knowledge deficit regarding pediatric pain management. The educational workshop and the provision of learning materials resulted in enhanced knowledge and attitudes that subsequently improved tutors' ability to effectively teach the topic to their students, with a clear implication for improvements in clinical practice. CLINICAL IMPLICATION: Educating nursing tutors about pediatric pain is imperative to enable students and thus future nurses to be equipped with the necessary evidence-based knowledge of how to manage pediatric pain.

Communication, information, involvement and decision making: A systematic scoping review of child-parent-nurse relationships during postoperative pain management.

AIMS: To examine the existing literature on child-parent-nurse relationships (in relation to communication, information, and involvement and decision-making) during postoperative pain management. BACKGROUND: Pain in children is under-reported and under-treated in hospitals and research has continued to report high rates of pain among hospitalised children worldwide. The role of child-parent-nurse relationships may be a factor and to date, no review has been identified that focus on these relationships during postoperative pain management. DESIGN: A systematic scoping review following Arksey and O'Malley with further adaptations based on JBI. METHODS: A systematic search for published primary studies was conducted using the Medline, CINAHL, British Nursing Index, ASSIA, PsycINFO, Science Direct and Web of Science in English from 2000 to 2022. Two reviewers independently carried out data screening and extraction and any differences were resolved with the assistance of a third reviewer. The data were analysed using thematic analysis and presented descriptively. This study followed the PRISMA-ScR Checklist. RESULTS: A total of 37 studies met the inclusion criteria. The findings mainly demonstrated a focus on the perspectives of parents and nurses with less on children's perspectives and none of the studies explored child-nurse relationships. The findings were categorised under three themes: communication, information, and involvement and decision making. CONCLUSION: A prevailing deficiency in child-parent-nurse relationships significantly contributed to suboptimal postoperative pain care, causing prolonged and untreated postoperative pain in children. Children's hesitation in communicating with nurses, the limited communication skills of nurses, and the weak communication position of parents in a hospital setting all hindered the development of strong relationships between children, parents, and nurses. The unclear definition of the roles of children and parents in postoperative pain management resulted in confusion for both parents and nurses. This was exacerbated by parents' lack of knowledge and inadequate guidance from nurses, ultimately leading to a decreased level of parental involvement in their child's postoperative pain management while in the hospital. Unattended requests for pain management caused children to experience prolonged pain and led to a deterioration in the relationship between parents and nurses, as well as a reduction in the parents' ability to provide pain care to their child. RELEVANCE TO CLINICAL PRACTICE: This study highlights the reasons behind the suboptimal management of postoperative pain in children. The importance of the relationship between children, parents, and nurses in pain management must be acknowledged, and the results of this study may be used to inform improvements in nursing pain management practices. NO PATIENT OR PUBLIC CONTRIBUTION: Patient or public contribution is not a necessary stage in a systematic scoping review following Arksey and O'Malley's framework.

Does Education Improve Nurses' Knowledge, Attitudes, Skills, and Practice in Relation to Pain Management? An Integrative Review.

BACKGROUND: Pain is undertreated in both adults and children and a major factor linked to this is nurses' lack of knowledge as evidenced by studies undertaken globally. OBJECTIVE: This review sought to explore the effects educational interventions can have on nurses' knowledge, attitudes, skills, and practice regarding pain management. DESIGN: An integrative review DATA SOURCES: Systematic search of CINAHL, MEDLINE, AMED, EMBASE, and Psych INFO. REVIEW/ANALYSIS METHODS: Five major databases were systematically searched from the year 2000-December 2019 with a total of 33 studies included in the final review. RESULTS: The literature revealed that many nurses had inadequate knowledge and a poor attitude towards pain at baseline, which may be improved through educational intervention. However, misconceptions remained at post-intervention, particularly regarding pharmacological pain management. CONCLUSIONS: Education is a possible means to enhance nurses' knowledge and improve attitudes and practices in pain management. However, there was some evidence that this may decline over time, and continuous professional updates are likely required.

Interactions between children, parents and nurses during postoperative pain management: A grounded theory study.

AIM: To explore the interactions between children, parents and nurses during postoperative pain management. BACKGROUND: Despite the growing evidence relating to postoperative pain management in children and relevant practice guidelines, children still experience moderate to severe pain after surgery. One factor could be related to the relatively unexplored child-parent-nurse interaction. DESIGN: A qualitative constructivist grounded theory methodology. METHODS: Data were collected from a paediatric hospital in the United Kingdom. Ten children aged between 6 and 11 years old who had undergone surgery, 11 parents and 10 nurses participated. Methods included face-to-face semi-structured interviews. Data were analysed using constant comparison technique, memos and constructivist grounded theory coding levels. The COREQ guidelines were followed for reporting. FINDINGS: Three concepts emerged from data, "Parents as a communicator for child-nurse interaction", "Parents' emotional turmoil in child-nurse interaction", and "Parents' actions in child-nurse interaction" which constructed the substantive theory of child-parent-nurse interaction during postoperative pain management: "Facilitating or Inhibiting Interactions: Parental Influence on Postoperative Pain Management". The findings highlight an absence of a three-way interaction between children, parents and nurses and a dyadic interaction process between children and nurses was not apparent. Instead, child-parent-nurse interactions were constructed around two dyads of child-parent and parent-nurse interactions with child-nurse interaction constructed via parents. Parents, as a communicator, influenced the entire postoperative pain management processes between children, parents and nurses by facilitating or inhibiting the interaction processes. CONCLUSIONS: This study identifies potentially important evidence about the unique position parents hold between their child and nurses as a central pivotal communicator during children's postoperative pain management. RELEVANCE TO CLINICAL PRACTICES: This study may help to explain how and why postoperative pain management remains suboptimal. The substantive theory could support improvements in the management of postoperative pain through a much wider recognition of parents' central pivotal communicator role and the complexity of these child-nurse interactions.

The impact of education on the knowledge and attitudes of Ghanaian nurse tutors towards the assessment and management of pain in children: A quantitative study.

BACKGROUND: Undertreatment of pain in children is an international problem as many children reports unresolved moderate to severe pain. One key factor which may contribute to under treatment of pain in children by nurses is lack of knowledge. In Ghana opportunities for nurses to learn about pediatric pain have been limited due to gaps in the undergraduate curriculum and inadequate continuing professional education post qualification. OBJECTIVE: To assess tutors' knowledge and attitudes to pediatric pain management before and after an educational workshop. DESIGN: Single group pre-test-post-test design. SETTING: One Ghanaian Nursing Training College. PARTICIPANTS: All (37) nursing tutors in the college. METHOD: Total population sampling was used to access 37 tutors, data were collected using the Knowledge and Attitude Survey Regarding Pain at 3 stages; pre-intervention, immediately after the train-the-trainer based Pediatric Pain Educational Workshop and at 3-months follow-up. Data from the survey were analyzed using descriptive and inferential statistics. RESULTS: Results at pre-intervention showed low scores in the survey. However, post-intervention results at both the immediate and 3-months follow-up stages revealed a significant increase from pre-intervention: Mean (SD) of 20.35 (4.56), to immediate follow-up Mean (SD) 26.93 (5.02), and 3-months follow-up Mean (SD) 25.19 (5.80) and a p-value of <0.001. CONCLUSION: The results suggest tutors' knowledge and attitudes regarding pediatric pain management can be directly improved through a nurse tutor focused educational program. However, knowledge declines with time and as such there is the need for regular update through Continuing Professional Development activities.

Recognising and assessing acute pain.

This article considers two areas of practice that are fundamental to the provision of high-quality nursing care for people experiencing acute pain: the initial recognition of pain, and the formal assessment of pain. The initial recognition of a patient's pain is a subject that is frequently overlooked in the literature. However, if nurses are unable to identify that a patient is experiencing pain, then a formal pain assessment may not take place, which in turn negatively affects the quality of any subsequent pain management. This article explores some of the barriers to the initial recognition of pain and examines how a formal pain assessment can support optimal patient care.

Pain: A content review of undergraduate pre-registration nurse education in the United Kingdom.

BACKGROUND: Pain is a global health issue with poor assessment and management of pain associated with serious disability and detrimental socio economic consequences. Pain is also a closely associated symptom of the three major causes of death in the developed world; Coronary Heart Disease, Stroke and Cancer. There is a significant body of work which indicates that current nursing practice has failed to address pain as a priority, resulting in poor practice and unnecessary patient suffering. Additionally nurse education appears to lack focus or emphasis on the importance of pain assessment and its management. DESIGN: A three step online search process was carried out across 71 Higher Education Institutes (HEIs) in the United Kingdom (UK) which deliver approved undergraduate nurse education programmes. Step one to find detailed programme documentation, step 2 to find reference to pain in the detailed documents and step 3 to find reference to pain in nursing curricula across all UK HEI websites, using Google and each HEIs site specific search tool. RESULTS: The word pain featured minimally in programme documents with 9 (13%) documents making reference to it, this includes 3 occurrences which were not relevant to the programme content. The word pain also featured minimally in the content of programmes/modules on the website search, with no references at all to pain in undergraduate pre-registration nursing programmes. Those references found during the website search were for continuing professional development (CPD) or Masters level programmes. CONCLUSION: In spite of the global importance of pain as a major health issue both in its own right, and as a significant symptom of leading causes of death and illness, pain appears to be a neglected area within the undergraduate nursing curriculum. Evidence suggests that improving nurse education in this area can have positive impacts on clinical practice, however without educational input the current levels of poor practice are unlikely to improve and unnecessary patient suffering will continue. Undergraduate nurse education in the UK needs to review its current approach to content and ensure that pain is appropriately and prominently featured within pre-registration nurse education.

Pedagogical principles underpinning undergraduate Nurse Education in the UK: A review.

BACKGROUND: This review provides a contextual report of the current use of pedagogy in undergraduate nursing programmes run by Higher Education Institutes (HEIs) in the United Kingdom (UK). Pedagogy provides the framework for educators to add shape and structure to the educational process, and to support student learning and programme development. Traditionally nurse education has used a behaviourist approach focusing on learning outcomes and competency based education, although there is also increasing support for the cognitive/student learning focused pedagogic approach. DESIGN: The keywords andragogy, pedagogy and student centred learning were used in a systematic stepwise descriptive content analysis of the programme specifications and programme handbooks of 40 current undergraduate programme documents, leading to an undergraduate award and professional registration as a nurse. RESULTS: 42% (17) of documents contained reference to the words, pedagogy and student centred learning, whilst no documents used the word andragogy. Where identified, pedagogy was used in a superficial manner, with only three documents identifying a specific pedagogical philosophy: one HEI citing a value based curriculum and two HEIs referencing social constructionism. Nine HEIs made reference to student centred learning but with no additional pedagogic information. A review of teaching, learning and assessment strategies indicated no difference between the documented strategies used by HEIs when comparing those with an espoused pedagogy and those without. CONCLUSION: Although educational literature supports the use of pedagogic principles in curriculum design, this is not explicit in undergraduate nursing programme documentation, and suggests that nurse educators do not view pedagogy as important to their programmes. Instead programmes appear to be developed based on operational and functional requirements with a focus on acquisition of knowledge and skills, and the fitness to practice of graduates entering the nursing workforce.

Nursing philosophy: A review of current pre registration curricula in the UK.

BACKGROUND: Nursing in the UK has been subject to criticism for failing to provide care and compassion in practice, with a series of reports highlighting inadequacies in care. This scrutiny provides nursing with an ideal opportunity to evaluate the underpinning philosophy of nursing practice, and for nurse educators to use this philosophy as the basis for programmes which can inculcate neophyte student nurses with a fundamental understanding of the profession, whilst providing other health care professionals and service users with a clear representation of professional nursing practice. DESIGN: The key word philosophy was used in a systematic stepwise descriptive content analysis of the programme specifications of 33 current undergraduate programme documents, leading to an undergraduate award and professional registration as a nurse. RESULTS: The word philosophy featured minimally in programme specification documents, with 12 (36%) documents including it. Its use was superficial in 3 documents and focused on educational philosophy in a further 3 documents. 2 programme specifications identified their philosophy as the NMC (2010) standards for pre-registration nurse education. 2 programme specifications articulated a philosophy specific to that programme and HEI, focusing on caring, and 2 made reference to underpinning philosophies present in nursing literature; the Relationship Centred Care Approach, and The Humanising Care Philosophy. CONCLUSION: The philosophy of nursing practice is not clearly articulated in pre-registration curricula. This failure to identify the fundamental nature of nursing is detrimental to the development of the profession, and given this lack of direction it is not surprising that some commentators feel nursing has lost its way. Nurse educators must review their current curricula to ensure that there is clear articulation of nursing's professional philosophical stance, and use this as the framework for pre-registration curricula to support the development of neophyte nursing students towards a clear and focused understanding of what nursing practice is.

The impact of experience on undergraduate preregistration student nurses' responses to patients in pain: a 2-year qualitative longitudinal study.

The management of pain is consistently reported as a problematic area of practice, with limited evidence of improvements in the past 30 years. This study explores the impact of experience on student nurses' responses to patients in pain. Sixteen volunteers from a cohort of undergraduate student nurses in the U.K. participated in a qualitative longitudinal study that used two semistructured interviews 18 months apart. Interview transcripts were analyzed with the use of thematic content analysis for each individual interview stage and then additionally to identify relationships between each stage. Participants revealed an initial lack of interest in nearly all aspects of pain. At the second stage of interviews, some participants expressed increasing discernment and empathy toward patients in pain, although some continued to have minimal interest. Findings suggest that an active interest in pain is essential so that individuals can react critically to assumptions of the clinical culture they are exposed to. Further research is needed to identify how an active interest can by developed among those students for whom experience has little positive impact. Without active interest, apathy, aversion to change, and continued poor pain management practices are likely to continue.

Registered nurses' personal responses to postoperative pain: a descriptive qualitative study.

This paper explores if nurses' personal responses to postoperative pain contribute to its continuing poor management. A descriptive qualitative design used a purposive sample of 16 registered nurses (RNs), from inpatient surgical areas in the United Kingdom, to participate in one semistructured interview. These were recorded and transcribed verbatim. Analysis used Morse and Field's four stages. A complex picture of collective and individual responses emerged; uncritical adoption of the medical model, with pain as normal and focus on technical aspects of management conforming to a "reference typology." However, individual RNs were also influenced by other personal factors, and findings indicate that scrutinizing individual competency is essential to improve individual and collective practice.