4.1 Practitioners views
In our study to develop the pain framework we asked practitioners how they felt about raising parents expectations of pain management.
Some practitioners were sympathetic stating parents’ expectations ‘may not be voiced, may not be asked’, suggesting that there is first a need to ‘understand’ parents’ expectations. Some practitioners however, expressed reservations about the possibility of setting unrealistic parental expectations, such as reducing pain to zero, that would then be difficult to meet.
Nonetheless, most thought that sharing realistic expectations was helpful, explaining that ‘use of (a) pain pathway helps with parents’ expectations of how their child’s pain will be managed’.
Participants felts parents’ expectations varied between ‘think[ing] their child will be in pain, and they think it’s normal’, and ‘expect their child won’t have any pain or shouldn’t have any pain’. So, although ‘we can’t get rid of all pain at all times’ there should be a commitment to ‘try and sort it out’.
Practitioners reflected that ‘parents’ understanding (of pain) should be checked, not assumed’, and noted that a ‘lack of assertiveness on the part of parents leads to frustration and perhaps avoidable poor pain management’, although parents should not be blamed for this. Parents’ expectations could be raised and managed through pain plans and outlining ‘how pain will be dealt with [and] be realistic and honest with parents’ and ‘educating them that pain management is not just about the drugs’.
Practitioners suggested ways of raising expectations including education and communication, giving parents ‘permission’ to ask about pain and stressing the need for nurses to talk to parents, for example: ‘pre-operative information for parents is seen as important to start the cycle of effective pain management. This can reduce the potential for stress and clarify expectations – which would lead to a good start to the admission’.
Other ways of raising expectations included signs or ‘posters or something in the parents’ room’ to prompt parents to ‘contact the pain team if you feel your child’s pain isn’t as well controlled’.
A consistent approach was deemed important in meeting or raising expectations although it was agreed that this was often dependent on the ‘individual nurses on the floor on that particular day unfortunately’. A pain consultant reported: ‘We can never over-deliver on pain management’ – suggesting the onus is the responsibility of the clinicians, rather than the parents with regards to setting the standard of care.
You can see from these responses that many practitioners are supportive of including parents in the management of their child’s pain. However, there seems to be recognition of the need for a shift in health care practitioners interactions with parents that actively encourages parents to become more involved in the management of their child’s pain in hospital.
Having covered all four sections of the pain management framework, you are now coming to the end of the course.
Activity 4: Six-minute briefing
Before you take the quiz, you might like to review your learning in the Children’s Pain Management Framework six-minute briefing. You can use the text box below to make notes of key points. Click on the link to access the leaflet which will provide an overview of the Pain Framework.