Graham J. Reid

Prevalence and source of pain in pediatric inpatients.

&NA; Our knowledge of the prevalence and sources of pain within hospital is limited. The present study is an epidemiological investigation of pain in a pediatric hospital. All children who were inpatients in a tertiary care hospital (excluding Neonatal ICU and psychiatry patients) and one parent per child were potential subjects. Interviews were conducted on three weekdays. Parent interviews were used for children less than 5 years of age (n = 102); child interviews were used for children age 5 years and older (n = 98). Subjects reported the intensity and source of the worst, usual and current pain during the past 24 h, and help received for pain. Medical and demographic variables and analgesics prescribed and administered were obtained from the medical record. Forty‐nine percent of subjects reported clinically significant levels of worst pain. Twenty‐one percent of subjects had clinically significant levels of usual pain. Causes of pain were variable and included disease, surgery, and intravenous lines (IV). Pain intensity was not significantly related to age, gender, patient type (medical, surgical), or diagnostic category. Children were given significantly less medication than was prescribed, regardless of their reported pain level. Nurses, mothers, and ‘no‐one’ were frequently reported as helping with pain. Medications and non‐pharmacological methods were reported as helpful in managing pain. Many children endure unacceptable levels of pain during hospitalization. Pain prevention and management must be more aggressive. Pain assessment should be approached with the same attention as vital signs. Improvements in analgesic prescription and administration practices and non‐pharmacological pain control methods are needed.

The Pain Coping Questionnaire: preliminary validation

&NA; A new measure of coping, the Pain Coping Questionnaire (PCQ), is presented and validated in two studies of children and adolescents. Factor analyses of data from healthy children and adolescents supported eight hypothesized subscales (information seeking, problem solving, seeking social support, positive self‐statements, behavioral distraction, cognitive distraction, externalizing, internalizing/catastrophizing) and three higher‐order scales (approach, problem‐focused avoidance, emotion‐focused avoidance). The subscales and higher‐order scales were internally consistent. The pain coping scales were correlated in the expected directions with childrens appraisals of pain controllability, self‐rated coping effectiveness, emotional distress when in pain, and among high school students, pain thresholds and functional disability. The structure and internal consistency of the PCQ were replicated in a sample of children and adolescents experiencing recurrent pain (headache, arthritis), and their parents. Relations between child‐ and parent‐ratings of childrens coping were moderate (median r=0.34). Higher levels of emotion‐focused avoidance were related to more emotional distress (both samples), less coping effectiveness (headache sample), and higher levels of pain (arthritis sample). Higher levels of approach coping were related to less disability (headache sample). Other relations between approach and distraction coping and the outcome variables were generally not significant. The PCQ is a promising instrument for assessing childrens pain coping strategies. The items are simple and relatively few, making it useful for assessing coping across a wide age range. It can be administered to children as young as 8 years of age in approximately 15 min.

Development and preliminary validation of a postoperative pain measure for parents

&NA; Parents are now primarily responsible for the at home assessment and treatment of their childrens pain following minor surgery. Although some research has suggested that parents underestimate their childrens pain following surgery, no behavioral measure exists to assist parents in pain assessment. The Postoperative Pain Measure for Parents was developed based on cues parents reported using to assess their childrens pain (e.g. changes in appetite, activity level). The purpose of the present study was to develop and validate this measure by examining the relation between parent‐report of child behaviors and child‐rated pain. Subjects were 110 children (56.4% male) aged 7–12 years undergoing day surgery at a tertiary‐care childrens hospital and their parents. Parents and children completed a pain diary for the 2 days following surgery. Children rated their pain and emotional distress and parents rated the presence or absence of specific behaviors from a checklist. Correlations were conducted between each of the 29 behavioral items and child‐rated pain on Day 1; 14 items with correlations less than 0.30 were dropped. The remaining 15 items were subjected to a principal axis factor analysis. A one‐factor solution was the best fit for the data. The items were then summed to yield a total score out of 15. Internal consistency reliabilities for the measure and correlations with child‐rated pain were high on both days following surgery. Child‐rated pain and emotional distress were moderately correlated. The Postoperative Pain Measure for Parents was also positively correlated with child‐rated emotional distress on both days following surgery. As child‐rated pain decreased from Day 1 to Day 2, so did scores on the behavioral measure. The Postoperative Pain Measure for Parents was successful in discriminating between children who had undergone no/low pain surgeries and children who had undergone moderate to high pain surgeries. There were no significant differences in scores on the behavioral measure for child age or sex. Using a cut‐off score of six out of 15, the measure showed excellent sensitivity (> 80%) and specificity (> 80%) in selecting children who reported clinically significant levels of pain. This study provides preliminary evidence for the use of the Postoperative Pain Measure for Parents as a valid assessment tool with children between the ages of 7–12 years following day surgery. It is internally consistent and strongly related to child‐rated pain. Future research should explore the use of this measure with a younger sample and children with developmental delays.

Impact of preoperative education on pain outcomes after coronary artery bypass graft surgery

&NA; Cardiovascular diseases cause more disability and economic loss in industrialized nations than any other group of diseases. In previous work [Nurs Res 49 (2000a) 1], most coronary artery bypass graft patients (CABG, N=225) reported unrelieved pain and received inadequate analgesics. This study proposed to evaluate a preadmission education intervention to reduce pain and related activity interference after CABG surgery. Patients (N=406) were randomly assigned to (a) standard care or (b) standard care+pain booklet group. Data were examined at the preadmission clinic and across days 1–5 after surgery. Outcomes were pain‐related interference (BPI‐I), pain (MPQ‐SF), analgesics (chart), concerns about taking analgesics (BQ‐SF), and satisfaction (American Pain Society‐POQ). The impact of sex was explored related to primary and secondary outcomes. The intervention group did not have better overall pain management although they had some reduction in pain‐related interference in activities (t(355)=2.54, P<0.01) and fewer concerns about taking analgesics (F(1,313)=2.7, P<0.05) on day 5. Despite moderate 24‐h pain intensity across 5 days, patients in both groups received inadequate analgesics (i.e. 33% prescribed dose). Women reported more pain and pain‐related interference in activities than men. The booklet was rated as helpful, particularly by women. In conclusion, the intervention did not result in a clinically significant improvement in pain management outcomes. In future, an intervention that considers sex‐specific needs and also involves educating the health professionals caring for these patients may influence these results.

Fostering children's resilience

Resilience is relevant to nurses because of its implications for health. Research on the resilience of children and adolescents has proliferated over the past five years. However, the specific processes underlying resilience and outcome variables require further study. Furthermore, few intervention studies have been conducted. This article describes resilience and factors that influence resilience of children, examines the relationship between resilience and health, identifies interventions that foster childrens resilience and health, reviews research focusing on childrens resilience, and suggests the relevance of resilience to nursing of children.

The relation between common sleep problems and emotional and behavioral problems among 2- and 3-year-olds in the context of known risk factors for psychopathology

The contribution of sleep problems to emotional and behavioral problems among young children within the context of known risk factors for psychopathology was examined. Data on 2‐ and 3‐year‐olds, representative of Canadian children without a chronic illness, from three cross‐sectional cohorts of the Canadian National Longitudinal Study of Child and Youth were analysed (n = 2996, 2822, and 3050). The person most knowledgeable (PMK), usually the mother, provided information about her child, herself, and her family. Predictors included: child health status and temperament; parenting and PMK depressive symptomatology; family demographics (e.g., marital status, income) and functioning. Child sleep problems included night waking and bedtime resistance. Both internalizing/emotional (i.e., anxiety) and externalizing/behavioral problems (i.e., hyperactivity, aggression) were examined. Adjusting for other known risk factors, child sleep problems accounted for a small, but significant, independent proportion of the variance in internalizing and externalizing problems. Structural equation models examining the pathways linking risk factors to sleep problems and emotional and behavioral problems were a good fit of the data. Results were replicated on two additional cross‐sectional samples. The relation between sleep problems and emotional and behavioral problems is independent of other commonly identified risk factors. Among young children, sleep problems are as strong a correlate of child emotional and behavioral problems as PMK depressive symptomatology, a well‐established risk factor for child psychopathology. Adverse parenting and PMK symptomatology, along with difficult temperament all contribute to both sleep problems and emotional and behavioral problems. Children’s sleep problems appear to exacerbate emotional and behavioral problems.

Accuracy of children's pain memories

Abstract Despite its importance in clinical practice, little research has examined memory for pain in children. This prospective study tried to justify the use of childrens pain recall in clinical practice. The purpose of this study was to (a) investigate the accuracy of childrens recall of their worst and average pain intensity when controlling for the effects of repeated pain measurement and (b) examine the influence of childrens anxiety, age, general memory ability and pain coping strategies on this accuracy. The accuracy of childrens recalled pain intensities was studied in 55 inpatients aged 5–16 years by comparing the level of recorded pain intensity with the level of recalled pain intensity 1 day and 1 week after recording using Bieris Faces Pain Scale. The accuracy of childrens recalled pain intensities was high and showed little decrement over 1 week. Older children had more accurate recall of their worst pain intensity. Anxiety, general memory ability and pain coping strategies were not related to accuracy of recalled pain intensities.

How Parents Seek Help for Children with Mental Health Problems

Parents seeking help for their child’s mental health problem face a complicated system of services. We examined how parents navigate the various services available. Sixty parents contacting a children’s mental health center were interviewed regarding their efforts and rationale in seeking help for their child. On average, in the year prior to the interview parents sought help for two different child problems, contacted five different agencies or professionals for help, and parents and/or children received two different treatments. One fifth of the time parents said they accepted treatments that they did not want. Almost all parents (87%) were simultaneously in contact with more than one agency at some point within the previous year. Future help-seeking models need to capture the iterative referral process that many parents experience.

Coping and Self-Medication in a Community Sample of Junior High School Students

OBJECTIVE: To examine differences between high and low catastrophizers in terms of pain, self-medication, coping, age and sex.

Psychological treatments for migraine.

Psychological and behavioral treatments for migraine are described and evidence for their efficacy is reviewed. Treatments for children, adolescents, and the elderly, and for menstrual migraine are then discussed. Biofeedback, relaxation, and stress-coping treatments have all demonstrated effectiveness. These treatments are effective for the majority of migraine sufferers and treatment effects are reliably maintained for periods of at least one year. Little is known about the mechanism behind the efficacy of psychological treatments. Suggestions for future research on treatment mechanisms, enhancement of treatment effectiveness, and increasing the acceptance of psychological treatments are provided.