An integrative review of interventions to support parents when managing their child’s pain at home

Version of record available at http://www.sciencedirect.com/journal/pain-management-nursing

Objectives: To identify interventions aimed at helping parents manage their child’s pain at home and to establish which aspects of interventions were effective. Design: Integrative narrative review. Data sources: MEDLINE, CINAHL Plus, PsychINFO, PsychArticles, AMED, PubMed, Scopus and Web of Knowledge were searched in 2016. Review methods: This narrative synthesis followed Centre for Reviews and Dissemination (2008), and Economic and Social Research Council guidance (Popay et al., 2006). Reasons attributed to intervention success were analyzed using content analysis. Results: From 2,534 papers, 17 were included. A majority were randomized controlled trials (n=13) and most addressed postoperative pain (n=15). A range of interventions were found which targeted parents directly, child-parent interactions and healthcare professional-parent interactions as well as complex interventions. Three studies were successful in reducing child pain at home and seven in increasing appropriate analgesic drug administration. Analysis of reasons attributed to interventions success revealed characteristics of interventions, components of parental pain management, and key features of research which aid researchers in designing and evaluating interventions. Risk of bias was present due to inadequate randomization, lack of a control group and underpowered studies. Conclusion: Nurses should be aware that targeting parents directly is the most effective way of reducing child pain at home. Nurses need to advocate for effective analgesics for their child patients as the ineffectiveness of many interventions was attributed to inadequate analgesic drugs. Once this is achieved success in increasing analgesic drug administration is most likely reached via parent-targeted interventions and those targeting healthcare professional-parent interactions. Successful interventions will be tailored to the child, and adequately powered. Including a measure of sedation will ensure sedation is not mistaken for analgesic effectiveness. Interventions should address multiple facets of pain management and include a measure of pain over a period as opposed to a snapshot in time.