Author Affiliations: Department of Nursing, Melbourne School of Health Sciences, University of Melbourne (Drs Plummer, Newall, and Manias), Australia; Children's Cancer Centre, Royal Children's Hospital (Drs Plummer and McCarthy), Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute (Drs Plummer, McCarthy, and Newall), Melbourne, Australia; Department of Pediatrics, Melbourne Medical School, University of Melbourne (Drs Plummer, McCarthy, and Newall), Australia; Department of Nursing Research, Royal Children's Hospital (Dr Newall), Melbourne, Australia; School of Nursing and Midwifery, Monash University (Dr Manias), School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation (Dr Manias), Melbourne, Australia; and Department of Medicine, Royal Melbourne Hospital, University of Melbourne (Dr Manias), Australia.
Cancer Nurs. 2024;47(2):151-162. doi: 10.1097/NCC.0000000000001199. Epub 2023 Jan 14.
Children undergoing hematopoietic stem cell transplantation (HSCT) are vulnerable to pain.
This study aimed to examine how healthcare providers and parents assessed pain and what contextual factors influenced their pain assessment practices for children hospitalized after allogeneic HSCT therapy.
A qualitative case study was conducted in a tertiary level pediatric HSCT unit in 2 phases. Semistructured interviews with parents were conducted at 30 and 90 days after HSCT therapy. Healthcare providers participated in naturalistic observations of pain-related care provided to children during their hospitalization for HSCT therapy and a semistructured interview.
The assessment of pain after transplantation by healthcare providers and parents was predominantly reliant on the observation of children for behaviors indicative of pain, rather than the application of validated pain assessment tools. Without formal measures of the pain experience, judgments regarding the severity of children's pain were influenced by the context of high acuity of care posttransplantation and the emotional responses of healthcare providers and parents from bearing witness to children's pain.
Pain assessments mostly reflected children's ability to tolerate pain, rather than a genuine measurement of how significantly pain impacted the child.
This study has emphasized how the assessment of pain for children hospitalized during HSCT therapy is limited by the complexity of the clinical environment. It is recommended that validated methods of assessing pain by healthcare providers and parents be implemented into clinical practice to ensure children's pain is visible.
接受造血干细胞移植（HSCT）的儿童易患疼痛。
本研究旨在探讨在异基因 HSCT 治疗后住院的儿童，医护人员和父母如何评估疼痛，以及哪些环境因素影响他们的疼痛评估实践。
在一家三级儿科 HSCT 病房进行了定性案例研究，分为两个阶段。在 HSCT 治疗后 30 天和 90 天，对父母进行半结构式访谈。医护人员参与了对儿童在 HSCT 治疗住院期间提供的与疼痛相关的护理的自然观察，并进行了半结构式访谈。
医护人员和父母对移植后疼痛的评估主要依赖于观察儿童的疼痛行为表现，而不是使用经过验证的疼痛评估工具。由于缺乏对疼痛体验的正式衡量标准，因此判断儿童疼痛的严重程度受到移植后护理高度急性的环境以及医护人员和父母目睹儿童疼痛时的情绪反应的影响。
疼痛评估主要反映了儿童对疼痛的耐受能力，而不是对疼痛对儿童影响程度的真实衡量。
本研究强调了在 HSCT 治疗期间住院的儿童的疼痛评估受到临床环境复杂性的限制。建议医护人员和父母在临床实践中实施经过验证的疼痛评估方法，以确保儿童的疼痛能够被看到。
