Pediatric postoperative pain management in postanesthesia care units in Norway - cluster randomized trial using different methodological approaches

Abstract

Many children experience pain after surgery, and pediatric postoperative pain is often underestimated and undertreated. Unrelieved pain may increase unnecessary suffering, complications after surgery, longer hospital stay, and for some patients, cause persistent postsurgical pain. Reasons for unrelieved pain may be that healthcare professionals lack knowledge and skills about postoperative pain management. Nurses working in the Postanesthesia Care Units (PACUs) play an essential role in pain management. The overall aim of this thesis was to gain a broader insight into pediatric postoperative pain management in PACUs in Norway, and to determine the feasibility and effect of a tailored educational intervention. The study has a cluster randomized design, using three different methodological approaches (survey for nurses, observation study of nurses’ clinical practice, and interviews with children) at three measurement points (before the intervention, one month, and six months after the intervention). The study was conducted at PACUs in six university hospitals. The nurses were cluster randomized by unit into an intervention or a control group. The intervention was based on previous research and results from data before the intervention, and it was tailored to meet local needs. It consisted of an educational day, clinical supervision, pain assessment tools, nonpharmacological pain-relieving equipment, and reminders. The main findings were that pediatric postoperative pain management was suboptimal. Nurses lack knowledge and skills in essential areas of postoperative pain management, and children experience moderate to severe pain. After the intervention, there was a positive change in pediatric postoperative pain management. Nurses’ knowledge and attitudes improved in the intervention group, but when adjusted for baseline differences, there were no overall significant differences in change between the two groups. Further research about pediatric pain management is needed.