Children's experiences of their postoperative pain management: a qualitative systematic review

Background Ineffective pain management for children postoperatively has been widely reported. An increasing amount of evidence recommends engaging children as active partners in their own pain management since pain is a subjective and individualized experience. Objective To synthesize the best available evidence on children's experiences of the management of their postoperative pain in the hospital and/or at home within a fortnight after a surgical procedure. Search Strategy Using a three-step search strategy, databases of CINAHL, MEDLINE, Scopus, ScienceDirect, Sociological Abstracts, PsycINFO, Web of Science, ProQuest and Mednar were searched for articles published in English up to 2010. Inclusion Criteria Types of studies Any qualitative studies including, but not limited to, methodologies such as phenomenology, grounded theory, descriptive qualitative studies and mixed methods studies were considered for inclusion. Types of participants Studies focused on 4- to-18-year-old children, who have undergone surgery in the hospital and stayed in surgical, day surgery wards or ambulatory care units. Phenomena of interest The review considered studies that included the following phenomena of interest: children's experiences related to their postoperative pain and pain management. Context Context included pediatric surgical wards in acute care hospital settings or in home settings within a fortnight after the surgery. Data Collection and Analysis Each paper was assessed independently and extracted by two independent reviewers using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. Any disagreement that arose between the reviewers was resolved through discussion with a third reviewer. Qualitative research findings were aggregated or synthesized to generate a set of statements that represent that aggregation. Main Results Six studies using interviews and containing qualitative evidence were included in this review. Three meta-syntheses were generated from 21 categories based on 59 findings: (1) Children experienced various negative emotions related to pain postoperatively. They are able to assess their own postoperative pain and interpret the causes of the pain. They may communicate their pain both verbally and non-verbally. However, children may conceal their feelings from nurses and require their parents to act as their advocates; (2) If children experience postoperative pain, then various non-pharmacological pain relieving strategies may be used by children, their parents and nurses in addition to pain medication; (3) Children suggested their parents and nurses use various non-pharmacological methods, give more and stronger pain medications to them without delay, and have more communication amongst nurses, parents and children. Conclusion Children, parents and nurses play important roles in pediatric pain management by being able to fulfill different needs of the children. There are many areas for improvements to provide better pediatric pain management.Qian Wen Sng, Beverley Joan Taylor, Lixia Zhu, Hong-Gu H