Jenkins Brooke N, Fortier Michelle A, Stevenson Robert, Makhlouf Mai, Lim Paulina, Converse Remy, Kain Zeev N
Department of Psychology, Chapman University, Orange, California.
Center on Stress and Health, University of California, Irvine, Orange, California.
Paediatr Anaesth. 2019 Jul;29(7):730-737. doi: 10.1111/pan.13649. Epub 2019 Jun 12.
Children who undergo surgery experience significant pain in the post anesthesia care unit. Nurse and parent behaviors in the post anesthesia care unit directly impact child postoperative pain. Therefore, we have developed and evaluated (Phase 1) and then tested (Phase 2) the feasibility of a new intervention (Nurse and Parent Training in Postoperative Stress) to alter parent and nurse behaviors in a way consistent with reducing child postoperative pain.
In Phase 1, a multidisciplinary team of experts (physicians, nurses, and psychologists) developed an empirically-based intervention which was then evaluated by experienced nurses (N = 8) and parents (N = 9) during focus groups. After revising the intervention based on focus group feedback, it was tested in Phase 2 using a pre-post study design. Nurses (N = 23) who worked in the recovery room were recruited to be part of both pre- and post-intervention data collection periods. Parents were recruited to be part of either the pre- (N = 52) or post-intervention (N = 60) data collection periods. Nurses and parent-child dyads were recorded in the post anesthesia care unit and videos were coded for the desired (ie, behaviors that may decrease child pain) and non-desired (ie, behaviors that may increase child pain) behaviors. Pain data was collected from the children's medical records to assess pain after surgery. The intervention was given to the nurses and parents in the post-intervention data collection period.
Nurses significantly increased their rate of desired behaviors by 231% (P = 0.001; Somer's D = 1) and significantly decreased their rate of non-desired behaviors by 62% (P = 0.004, Somer's D = -0.88, 95% CI [-1.74, -0.03]). Parents significantly increased their rate of desired behaviors by 124% (P = 0.033). Moreover, the intervention significantly decreased child pain in the post anesthesia care unit (b = -2.19, SE = 0.63, z = -3.46, P = 0.001, 95%CI [-3.43, -0.95]).
The intervention was effective in changing nurse and parent behaviors as well as child pain after surgery.
接受手术的儿童在麻醉后护理单元会经历剧烈疼痛。麻醉后护理单元中护士和家长的行为会直接影响儿童术后疼痛。因此，我们开发并评估了（第1阶段），然后测试了（第2阶段）一种新干预措施（术后应激中的护士和家长培训）的可行性，以改变家长和护士的行为，使其与减轻儿童术后疼痛的方式保持一致。
在第1阶段，一个多学科专家团队（医生、护士和心理学家）开发了一种基于实证的干预措施，然后由经验丰富的护士（N = 8）和家长（N = 9）在焦点小组中进行评估。根据焦点小组的反馈对干预措施进行修订后，在第2阶段使用前后研究设计进行测试。招募在恢复室工作的护士（N = 23）参与干预前和干预后的数据收集期。招募家长参与干预前（N = 52）或干预后（N = 60）的数据收集期。在麻醉后护理单元对护士和亲子二元组进行记录，并对视频中期望的（即可能减轻儿童疼痛的行为）和非期望的（即可能增加儿童疼痛的行为）行为进行编码。从儿童病历中收集疼痛数据，以评估术后疼痛情况。在干预后的数据收集期对护士和家长实施干预措施。
护士期望行为的发生率显著提高了231%（P = 0.001；索末斯D = 1），非期望行为的发生率显著降低了62%（P = 0.004，索末斯D = -0.88，95%可信区间[-1.74, -0.03]）。家长期望行为的发生率显著提高了124%（P = 0.033）。此外，该干预措施显著减轻了麻醉后护理单元中儿童的疼痛（b = -2.19，标准误 = 0.63，z = -3.46，P = 0.001，95%可信区间[-3.43, -0.95]）。
该干预措施在改变护士和家长的行为以及术后儿童疼痛方面是有效的。
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