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Article Excerpt
Day surgery is especially common among children because they are described to benefit from it (Lonnqvist & Morton, 2006). An economical benefit may include short stay at the hospital, and day-surgery interrupts family life less than in-patient surgery. This is a challenge for children's post-operative pain management because the responsibility for the effective postoperative pain relief has become a parental duty. Several studies show that children have significant postoperative pain at home (Hamers & Abu-Saad, 2002; Kankkunen, Vehvilainen-Julkunen, Pietila, & Kiviniemi, 2005; Matziou, Kyritsi, & Perdikaris, 2004; Sutters et al., 2007; Tuomilehto, Kokki, Ahonen, & Nuutinen, 2002) and that there is a need to improve children's pain management (Zisk, 2003). It has been suggested that parents are able to manage the child's post-operative pain at home appropriately if they are provided with information and instructions about the timing and dosing of analgesia on discharge (Jonas, 2003; Sepponen, Kokki, & Ahonen 1999). Therefore, it is essential that parents are provided with sufficient information, support, and tools to assess and manage their child's pain at home (Bastable & Rushforth, 2005).
It is known that dosing of analgesics is not at an optimal level at home and that all children do not receive pain medication even if parents assess them to have pain postoperatively (Huth & Broome, 2007). Inadequate prescription of medication and insufficient administration of the prescribed medication are considered the main reasons for children's poor pain relief at home (Hamers, AbuSaad, van den Houten, & Halfens, ]998).
Earlier studies report that several parental factors hinder children's effective pain relief at home after surgery. Parents may expect the child to have pain after surgery (Romsing & Walther-Larsen, 1996), and fathers have highlighted the need to tolerate pain among boys (Kankkunen, Vehvilainen-Julkunen, Pietila, & Halonen, 2003). Parents fear side effects, consider analgesics as addictive, and think that the less often children receive analgesia, the better it worked (Kankkunen, Vehvilaiinen-Julkunen, Pietilai, Kokki, & Halonen, 2003; Zisk, Grey, MacLaren, & Kain, 2007). Parents may also believe that children are unable to feel pain or they may consider analgesics to be dangerous for the child (Gedaly-Duff & Ziebarth, 1994; Kankkunen, Vehvilainen-Julkunen, Pietilai, Kokki et al., 2003). Parents' attitudes toward children receiving pain medication are also dependent on the parents' own experiences of surgery (Riddel, Lilley, & Craig, 2004). These unsubstantiated and negative attitudes about children's pain and analgesics explain inadequate use of analgesics in children's post-operative pain management at home (Kankkunen, Vehvilaiinen-Julkunen, Pietila, & Kiviniemi, 2005).
Preliminary evidence suggests that the use of the Parents' Post-Operative Pain Measure (PPPM) promotes 1 to 6-year-old children's non-pharmacological pain alleviation at home after surgery. Lehikoinen (2007) found that the parents who were given the PPPM used several non-pharmacological pain alleviation methods more than parents in the control group. However, no differences in the use of analgesics between the intervention group and the control group of parents were found. Lehikoinen (2007) studied children ages 1 to 6 years. According to Bonham (1996), children's responses to pain differ during their developmental stages. Children ages 1 to 3 years express their pain mainly by crying, screaming, identifying pain location, and talking aggressively, while older children can describe the intensity of pain. Therefore, it was necessary to explore the influence of the PPPM with children ages 1 to 2 years who express their pain in a similar way.
The purpose of this study was to evaluate the influence of parental use of PPPM on the use of pain medication at home for 1 to 2-year-old children. The research questions were:
* How intensive is children's postoperative pain at home during the day of surgery and on the first two post-operative days?
* Which analgesics do parents give to their children at home?
* How much are analgesics used among the children?
* How does the use of PPPM influence in the total amount of analgesics and the optimal dose given to the child?
Methods
Sample and Setting
Parents of 100 children scheduled for day surgery in three university hospitals in Finland were invited to participate in the study between January 2006 and June 2007. The parents of 50 children between 1 and 2 years of age agreed to participate, and 50 refused to participate. One parent from each family participated in the study. Convenience sampling was used. The study nurses invited every second consecutive parent whose child had a surgical day case procedure into the intervention (n = 29) or control group (n = 21). Every parent was asked to participate: first parent to the intervention group, second parent to the control group,...
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