A Survey of Caregiver Perspectives on Children’s Pain Management in the Emergency Department

Abstract

Objectives: We explored caregiver perspectives on their children's pain management in both a pediatric (PED) and general emergency department (GED). Study objectives were to: (1) measure caregiver estimates of children's pain scores and treatment; (2) determine caregiver level of satisfaction; and (3) determine factors associated with caregiver satisfaction. Methods: This prospective survey examined a convenience sample of 97 caregivers (n = 51 PED, n = 46 GED) with children aged <17 years. A paper-based survey was distributed by research assistants, from 2009-2011. Results: Most caregivers were female (n = 77, 79%) and were the child's mother (n = 69, 71%). Children were treated primarily for musculoskeletal pain (n = 41, 42%), headache (n = 16, 16%) and abdominal pain (n = 7, 7%). Using a 100 mm Visual Analog Scale, the maximum mean reported pain score was 75 mm (95% CI: 70-80) and mean score at discharge was 39 mm (95% CI: 32-46). Ninety percent of caregiver respondents were satisfied (80/89, 90%); three (3/50, 6%) were dissatisfied in the PED and six (6/39, 15%) in the GED. Caregivers who rated their child's pain at ED discharge as severe were less likely to be satisfied than those who rated their child's pain as mild or moderate (p = 0.034). Conclusions: Despite continued pain upon discharge, most caregivers report being satisfied with their child's pain management. Caregiver satisfaction is likely multifactorial, and physicians should be careful not to interpret satisfaction as equivalent to adequate provision of analgesia. The relationship between satisfaction and pain merits further exploration. RÉSUMÉObjectifs: L'étude a porté sur le point de vue des aidants quant à la prise en charge de la douleur chez les enfants dans un service des urgences pédiatriques (SUP) et dans un service des urgences générales (SUG). L'étude visait à: 1) mesurer l'intensité de la douleur chez les enfants, estimée par les aidants ainsi que le traitement appliqué; 2) déterminer le degré de satisfaction des aidants; et 3) déterminer les facteurs associés à la satisfaction des aidants. Méthode: Il s'agit d'une enquête prospective, menée dans un échantillon de commodité de 97 aidants (SUP: n = 51; SUG: n = 46) qui accompagnaient des enfants de moins de 17 ans. Des questionnaires d'enquête sur papier ont été distribués par des assistants de recherche, de 2009 à 2011. Résultats: La plupart des aidants étaient des femmes (n = 77; 79 %) et, bien souvent, la mère des enfants (n = 69; 71 %). Les enfants étaient traités surtout pour des douleurs musculosquelettiques (n = 41; 42 %), des céphalées (n = 16; 16 %) et des douleurs abdominales (n = 7; 7 %). Le score maximal moyen, indiqué sur une échelle visuelle analogue de 100 mm s'élevait à 75 mm (IC à 95 %: 70-80) et le score moyen au moment du congé était de 39 mm (IC à 95 %: 32-46). Quatrevingt-dix pour cent des aidants qui ont répondu à l'enquête se sont dits satisfaits (n = 80/89; 90 %); 3 (n = 3/50; 6 %) au SUP et 6 (n = 6/39; 15 %) au SUG ne l'étaient pas. Les aidants qui ont ...

Is caregiver refusal of analgesics a barrier to pediatric emergency pain management? A cross-sectional study in two Canadian centres

“…Pain severity at discharge is not predictive of caregiver satisfaction. 54,55 Therefore, we assessed both global satisfaction with care and satisfaction specific to pain management. Global judgments of satisfaction with treatment is a core outcome domain outlined by the Pediatric Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (Ped-IMMPACT) consensus.…”

“…However, this approach was the single best available strategy for the assessment of pre-arrival pain. It is possible that differences between parental perception of pain and pain reported by a child could have been because of different scales, but it is unlikely given the high correlation between the NRS and FPS-R. 25,26 Retrospective pain assessments in children are commonly used, 54,62 and although evidence specific to pain is lacking, the ability to accurately recall states such as hunger appear to be present from age four onwards. 63 There is also good agreement between the pain questionnaires with a short recall interval (14 days) and prospective pain diaries.…”

Children’s satisfaction and dissatisfaction with pain management in a Pediatric Emergency Department

“…Special attention should be given to children by preparing them for the procedures. To this end, the family and other team members play a key role in this preparation and reduce their anxiety (24)(25) . The active participation of children in their care should be encouraged both by professionals and their families, hence taking into consideration their right to voice and participation in health care (26) .…”

A satisfação da criança e da família acerca do manejo da dor em um pronto-socorro infantil

“…Outros estudos demostram a importância da comunicação para os pais, enumerando alguns aspectos indispensáveis e facilitadores durante a transmissão das informações como: a facilidade de entendimento, comunicação clara, consistente e completa, para que consigam entender a mensagem transmitida (Brown et al, 1995;Davis, 1995;Byczkowski et al, 2013); a interação e comunicação com qualidade, nas quais as informações sejam úteis e necessárias para os familiares Ali et al, 2016) e a comunicação direta com a criança, dando-lhe a oportunidade de entender e fazer parte do cuidado (Davis, 1995;Byczkowski et al, 2016) Para as crianças, a atenção e o cuidado da equipe de saúde são essenciais, pois as ajudam no entendimento da situação vivida naquele momento, facilita a colaboração, uma vez que elas conseguem entender o que está sendo feito e como está sendo feito, favorecendo o alívio mais rápido da dor. No trabalho de Weingarten et al (2014) sobre a perspectiva da criança no manejo da dor no pronto-socorro infantil, as crianças indicaram a importância da escuta ativa e do questionamento direcionado a elas.…”

“…A televisão, música, massagem, entre outros, colaboram para a distração da criança, durante os procedimentos dolorosos. Nesse âmbito, a distração para as crianças foi avaliada pelos pais como satisfatória Ali et al, 2016;Byczkowski, et al, 2016). É importante também que os profissionais não culpem as crianças quando algo sair diferente do planejado, como por exemplo, uma punção malsucedida, ou uma infiltração, que podem ocorrer durante o atendimento.…”