Tokenism or true partnership: Parental involvement in a child’s acute pain care

Abstract

Aims and objectives To explore parental involvement in the child's acute pain care and establish ways in which parental preferences for involvement in their child's care can be identified, facilitated and enhanced by nurses. Background Despite growing evidence supporting effective acute pain management in children and the availability of national and international practice guidelines, children still experience acute pain. Involving parents in their child's pain care has been identified as being a central tenet of pain management in children. Design and methods A qualitative study using an ethnographical approach with nonparticipant observation and follow‐up semi‐structured interviews was undertaken. Nurses (n = 14), parents (n = 41), grandparents (n = 2), other relative (n = 1) and children (n = 30) participated. The framework approach underpinned data analysis. Consolidated criteria for reporting qualitative research (COREQ) enabled comprehensive reporting of the study. Results Three concepts emerged from the data: “parents as advocates for their child,” “nurses promoting involvement and partnership” and “nurses unintentionally preventing involvement and partnership.” Variations in the way parents were involved in their child's pain care were identified. Despite family‐centred care being the dominant model of involving families in their child's care, evidence of this being implemented was limited. Parents attempted to advocate effective pain care for their child, whether or not they were supported by nurses. Conclusions Parental involvement in their child's acute pain care can improve the child's pain experience, reduce parental anxiety and increase parents’ satisfaction in care. Nurses aspired to involve parents in pain care, but did not always enact this in practice. Relevance for practice Children deserve optimum pain care, which includes parental involvement. Parental involvement underpinned by the principles of family‐centred care was poorly implemented. Parents attempted to be involved and advocate for their child's pain care whether or not they were supported by nurses. An alternative approach for supporting parents to advocate in their child's acute pain care is offered, the “Partnership in Pain Care Model.”

When the paediatric intensive care unit becomes home: A hermeneutic‐phenomenological study

“…Shaw, Suonpera's study of NICU documentation is a good example as it demonstrated that minimal attention was given to parental involvement in nurses' notes. Although the lack of parental involvement as an outcome has strong evidence in the literature, little is known about the process by which parents are advertently or inadvertently excluded from care . The current study sheds light on this process by articulating nurses' experience of negotiating spaces with families and their associated gatekeeping comportments.…”

“…Despite parents' desire to be implicated in care, parental involvement has remained parsimonious . Shaw, Suonpera's study of NICU documentation is a good example as it demonstrated that minimal attention was given to parental involvement in nurses' notes.…”

Developing a Framework to Support the Delivery of Effective Pain Management for Children: An Exploratory Qualitative Study

“…However, nurses may not take as active a role as they could do in managing children's pain, seeing it as the parents' and child's responsibility to inform them when they are experiencing pain [10]. Sharing information with parents and valuing their knowledge of their child and communicating in an equal partnership can establish parents' expectations of involvement in the management of their child's pain [11][12][13]. However, a lack of communication and information provision and poor negotiation of roles can result in missed opportunities for nurses to work in partnership with parents even when parents attempt to be involved and advocate for their child's pain care [11][12][13].…”

“…Where parents (and children) are given information on pain management, studies have shown that this results in satisfaction with care [9]. However, a lack of communication, information provision, and poor negotiation of roles can result in missed opportunities for nurses to work in partnership with parents [11]. Sometimes, information provision can be inconsistent, resulting in parents having sufficient information about some aspects (e.g., the surgical procedure) but not others (e.g., pain medication) [31].…”

Factors associated with parents’ experiences using a knowledge translation tool for vaccination pain management: a qualitative study

“…Making evidence-based strategies for vaccination pain management available to parents is critical as parental concern regarding needle pain has been identified as a significant barrier to children receiving their vaccinations [5]. Parents can be powerful advocates for their child's pain management [7], however scientific evidence on pain management is often inaccessible to parents [3], both physically and in terms of language.…”