Top

BMC Pediatrics

Published in:

01-12-2020 | Research article

Dynamics on the field: a focused study on the culture and context of pediatric pain management at four Ghanaian hospitals

Authors: Abigail Kusi Amponsah, Evans Oduro, Victoria Bam, Joana Kyei-Dompim, Collins Kwadwo Ahoto, Anna Axelin

Published in: BMC Pediatrics | Issue 1/2020

Abstract

Background

As part of efforts to develop and implement a short course educational program on pediatric pain management, the current study sought to understand the culture and contextual factors that influence children’s pain management in order to improve the practice in pediatric care settings.

Methods

Guided by Bourdieu’s theory of practice, a focused ethnographic study was conducted from October, 2018 to February, 2019. The study was contextualized at four Ghanaian hospitals among purposefully sampled nurses, physicians, hospitalized children and their families. During the 20-week study period, three ethnographers spent 144 h conducting participant-observation sessions. Formal and informal interviews were held with participants in addition to review of hospital records.

Results

Analysis of the field data resulted in four themes. “Children’s pain expression and response of caregivers” described the disposition (habitus) of both children and caregivers to act in particular ways due to children’s incomplete health status (bodily capital) which caused them pain and also resulted in discomforting procedures. “Pharmacological pain management practices and attitudes” elucidated the use of analgesics as the mainstay disposition (habitus) in children’s pain management due to high level of respect (symbolic capital) given to such interventions on the pediatric units (field). “Managing pain without drugs” illustrated healthcare providers and family caregivers’ disposition (habitus) of using diverse nonpharmacological methods in managing children’s pain. “Communication and interaction between pain actors” depicted how children’s access to care givers (social capital) can serve as a powerful tool in influencing pediatric pain assessment and management disposition (habitus) on the pediatric units (field).

Conclusions

The habitus of pediatric pain actors toward pain assessment and management practices are influenced by various forms of capital (social, cultural, symbolic, bodily and economic) operating at different levels on the pediatric care field. Quality improvement programs that seek to enhance pediatric pain management should use the insights obtained in this study to guide the development, implementation and evaluation stages.

Available only for authorised users

Birnie KA, Noel M, Parker JA, Chambers CT, Uman LS, Kisely SR, et al. Systematic review and meta-analysis of distraction and hypnosis for needle-related pain and distress in children and adolescents. J Pediatr Psychol. 2014;39:783–808. https://doi.org/10.1093/jpepsy/jsu029.CrossRefPubMedPubMedCentral

Friedrichsdorf SJ, Sidman J, Krane EJ. Prevention and treatment of pain in children. Otolaryngol Neck Surg. 2016;154:804–5. https://doi.org/10.1177/0194599816636100.CrossRef

Rosenfeld RM, Sury K, Mascarinas C. Office insertion of tympanostomy tubes without anesthesia in young children. Otolaryngol Neck Surg. 2015;153:1067–70. https://doi.org/10.1177/0194599815608366.CrossRef

Stevens BJ, Abbott LK, Yamada J, Harrison D, Stinson J, Taddio A, et al. Epidemiology and management of painful procedures in children in Canadian hospitals. Can Med Assoc J. 2011;183:E403–10. https://doi.org/10.1503/cmaj.101341.CrossRef

Sinatra R. Causes and consequences of inadequate management of acute pain. Pain Med. 2010;11:1859–71. https://doi.org/10.1111/j.1526-4637.2010.00983.x.CrossRefPubMed

Zarpelon A, Cunha T, Alves-Filho J, Pinto L, Ferreira S, McInnes I, et al. IL-33/ST2 signalling contributes to carrageenin-induced innate inflammation and inflammatory pain: role of cytokines, endothelin-1 and prostaglandin E ₂. Br J Pharmacol. 2013;169:90–101. https://doi.org/10.1111/bph.12110.CrossRefPubMedPubMedCentral

Galozzi P, Maghini I, Bakdounes L, Ferlito E, Lazzari V, Ermani M, et al. Prevalence of low back pain and its effect on health-related quality of life in 409 scholar adolescents from the Veneto region. Reumatismo. 2019;71:132–40. https://doi.org/10.4081/reumatismo.2019.1229.CrossRefPubMed

Abu-Saad Huijer H, Sagherian K, Tamim H. Quality of life and symptom prevalence as reported by children with cancer in Lebanon. Eur J Oncol Nurs. 2013;17:704–10. https://doi.org/10.1016/j.ejon.2013.09.004.CrossRefPubMed

Windsor RS, Corcoran AL, Lenburg CB, Burnside H, Davitz LJ, Tamura T, et al. Relaxation and guided imagery do not reduce stress, pain and unpleasantness for 11- to 12-year-old girls during vaccinations. Pediatr Nurs. 2015;15:5. https://doi.org/10.1111/apa.13000.CrossRef

10.

Nelson LP, Gold JI. Posttraumatic stress disorder in children and their parents following admission to the pediatric intensive care unit. Pediatr Crit Care Med. 2012;13:338–47. https://doi.org/10.1097/PCC.0b013e3182196a8f.CrossRefPubMed

11.

Forgeron PA, King S, Stinson JN, McGrath PJ, MacDonald AJ, Chambers CT. Social functioning and peer relationships in children and adolescents with chronic pain: a systematic review. Pain Res Manag. 2010;15:27–41. https://doi.org/10.1155/2010/820407.CrossRefPubMedPubMedCentral

12.

Mathews L. Pain in children: neglected, unaddressed and mismanaged. Indian J Palliat Care. 2011;17(Suppl):S70–3. https://doi.org/10.4103/0973-1075.76247.CrossRefPubMedPubMedCentral

13.

Ojeda B, Salazar A, Dueñas M, Torres LM, Micó JA, Failde I. The impact of chronic pain: the perspective of patients, relatives, and caregivers. Fam Syst Health. 2014;32:399–407. https://doi.org/10.1037/fsh0000069.CrossRefPubMed

14.

Goldberg DS, McGee SJ. Pain as a global public health priority. BMC Public Health. 2011;11:770. https://doi.org/10.1186/1471-2458-11-770.CrossRefPubMedPubMedCentral

15.

Cousins MJ, Lynch ME. The declaration Montreal: access to pain management is a fundamental human right. Pain. 2011;152:2673–4. https://doi.org/10.1016/j.pain.2011.09.012.CrossRefPubMed

16.

Lim Y, Godambe S. Prevention and management of procedural pain in the neonate: an update, American Academy of Pediatrics, 2016. Arch Dis Child - Educ Pract Ed. 2017;102:254–6. https://doi.org/10.1136/archdischild-2016-311066.CrossRefPubMed

17.

Spence K, Henderson-Smart D, New K, Evans C, Whitelaw J, Woolnough R, et al. Evidenced-based clinical practice guideline for management of newborn pain. J Paediatr Child Health. 2010;46:184–92. https://doi.org/10.1111/j.1440-1754.2009.01659.x.CrossRefPubMed

18.

Witt N, Coynor S, Edwards C, Bradshaw H. A guide to pain assessment and management in the neonate. Curr Emerg Hosp Med Rep. 2016;4:1–10. https://doi.org/10.1007/s40138-016-0089-y.CrossRefPubMedPubMedCentral

19.

Taddio A, Appleton M, Bortolussi R, Chambers C, Dubey V, Halperin S, et al. Reducing the pain of childhood vaccination: an evidence-based clinical practice guideline (summary). Can Med Assoc J. 2010;182:1989–95. https://doi.org/10.1503/cmaj.092048.CrossRef

20.

Esmaili BE, Stewart KA, Masalu NA, Schroeder KM. Qualitative analysis of palliative care for pediatric patients with cancer at Bugando medical center: an evaluation of barriers to providing end-of-life care in a resource-limited setting. J Glob Oncol. 2018;4:1–10. https://doi.org/10.1200/JGO.17.00047.CrossRefPubMed

21.

Hill M, Stevens D. Volunteers who manage other volunteers and the professionalisation of volunteer management: implications for practice. Volunt Sect Rev. 2011;2:107–14. https://doi.org/10.1332/204080511X560657.CrossRef

22.

Finley GA, Kristjánsdóttir O, Forgeron PA. Cultural influences on the assessment of children’s pain. Pain Res Manag. 2009;14:33–7. https://doi.org/10.1155/2009/763031.CrossRefPubMedPubMedCentral

23.

Stevens B, Riahi S, Cardoso R, Ballantyne M, Yamada J, Beyene J, et al. The influence of context on pain practices in the NICU: perceptions of health care professionals. Qual Health Res. 2011;21:757–70. https://doi.org/10.1177/1049732311400628.CrossRefPubMed

24.

Atran S, Medin DL, Ross NO. The cultural mind: environmental decision making and cultural modeling within and across populations. Psychol Rev. 2005;112:744–76. https://doi.org/10.1037/0033-295X.112.4.744.CrossRefPubMed

25.

Laws RA, Kemp LA, Harris MF, Davies GP, Williams AM, Eames-Brown R. An exploration of how clinician attitudes and beliefs influence the implementation of lifestyle risk factor management in primary healthcare: a grounded theory study. Implement Sci. 2009;4:66. https://doi.org/10.1186/1748-5908-4-66.CrossRefPubMedPubMedCentral

26.

Carel H, Kidd IJ. Epistemic injustice in healthcare: a philosophial analysis. Med Health Care Philos. 2014;17:529–40. https://doi.org/10.1007/s11019-014-9560-2.CrossRefPubMed

27.

Nortjé N, Albertyn R. The cultural language of pain: a south African study. S Afr Fam Pract. 2015;57:24–7. https://doi.org/10.1080/20786190.2014.977034.CrossRef

28.

Fortier MA, Martin SR, Kain DI, Tan ET. Parental attitudes regarding analgesic use for children: differences in ethnicity and language. J Pediatr Surg. 2011;46:2140–5. https://doi.org/10.1016/j.jpedsurg.2011.06.021.CrossRefPubMed

29.

Twycross A, Finley GA. Nurses’ aims when managing pediatric postoperative pain: is what they say the same as what they do? J Spec Pediatr Nurs. 2014;19:17–27. https://doi.org/10.1111/jspn.12029.CrossRefPubMed

30.

Kikuta A, Gardezi F, Dubey V, Taddio A. Practices and perceptions regarding pain and pain management during routine childhood immunizations: findings from a focus-group study with nurses working at Toronto public health, Ontario. Can J Infect Dis Med Microbiol. 2011;22:43–8. https://doi.org/10.1155/2011/381864.CrossRefPubMedPubMedCentral

31.

Ghana Health Service. The health sector in Ghana: facts and figures. Accra: Ghana Health Service; 2017. https://www.ghanahealthservice.org/downloads/FACTS+FIGURES_2017.pdf. Accessed 13 May 2020.

32.

Aryeetey GC, Westeneng J, Spaan E, Jehu-Appiah C, Agyepong IA, Baltussen R. Can health insurance protect against out-of-pocket and catastrophic expenditures and also support poverty reduction? Evidence from Ghana’s National Health Insurance Scheme. Int J Equity Health. 2016;15:116.

33.

Ahenkan A, Aduo-Adjei K. Predictors of patient satisfaction with quality of healthcare in university hospitals in Ghana. Hosp Pract Res. 2017;2:9–14.CrossRef

34.

Elikplim Pomevor K, Adomah-Afari A. Health providers’ perception of quality of care for neonates in health facilities in a municipality in southern Ghana. Int J Health Care Qual Assur. 2016;29:907–20.CrossRefPubMed

35.

Kusi Amponsah A, Kyei EF, Agyemang JB, Boakye H, Kyei-Dompim J, Ahoto CK, et al. Nursing-related barriers to children’s pain management at selected hospitals in Ghana: a descriptive qualitative study. Pain Res Manag. 2020;2020:1–7. https://doi.org/10.1155/2020/7125060.CrossRef

36.

Kusi Amponsah A, Kyei-Dompim J, Bam V, Kyei EF, Oduro E, Ahoto CK, et al. Exploring the educational needs of nurses on children’s pain management: A descriptive qualitative study. Nurs Open. 2020:nop2.459. https://doi.org/10.1002/nop2.459.

37.

Beckett K, Henderson EM, Parry S, Stoddart P, Fletcher M. A mixed-method study of pain management practice in a UK children’s hospital: identification of barriers and developing strategies to maintain effective in-patient paediatric pain management. Nurs Open. 2016;3:19–29. https://doi.org/10.1002/nop2.33.CrossRefPubMed

38.

Kruk ME, Gage AD, Arsenault C, Jordan K, Leslie HH, Roder-DeWan S, et al. High-quality health systems in the sustainable development goals era: time for a revolution. Lancet Glob Health. 2018;6:e1196–252. https://doi.org/10.1016/S2214-109X(18)30386-3.CrossRefPubMedPubMedCentral

39.

Bourdieu P, Nice R. Outline of a theory of practice. Cambridge: Cambridge University Press; 1977. https://doi.org/10.1017/CBO9780511812507.CrossRef

40.

Pole C, Morrison M. Ethnography for education. United Kingdom: McGraw-Hill Education; 2003.

41.

McCambridge J, Witton J, Elbourne DR. Systematic review of the Hawthorne effect: New concepts are needed to study research participation effects. J Clin Epidemiol. 2014;67:267–77. https://doi.org/10.1016/j.jclinepi.2013.08.015.CrossRefPubMedPubMedCentral

42.

Spradley JP, McCurdy DW. Anthropology, the cultural perspective. 2nd ed. California: Wiley; 1980.

43.

Amaechi EC, Fusch PI. Investigators reflections on the process and experience of a mini-ethnographic case study research in Nigeria. Qual Rep. 2019;24:550–8 https://nsuworks.nova.edu/tqr/vol24/iss3/8. Accessed 11 Dec 2019.

44.

Leininger MM. Ethnonursing: a research method with enablers to study the theory of culture care. In: Leininger MM, McFarland MR, editors. Culture care diversity and universality: a worldwide theory of nursing. 2nd ed. Sudbury: Jones and Bartlett Publishers; 2006. p. 43–82.

45.

Guba EG, Lincoln YS. Fourth generation evaluation. Thousand Oaks: Sage Publications, Inc.; 1989.

46.

Lipsitz LA. Understanding health care as a complex system: the foundation for unintended consequences. JAMA. 2012;308:243–4. https://doi.org/10.1001/jama.2012.7551.CrossRefPubMedPubMedCentral

47.

Kannampallil TG, Schauer GF, Cohen T, Patel VL. Considering complexity in healthcare systems. J Biomed Inform. 2011;44:943–7. https://doi.org/10.1016/J.JBI.2011.06.006.CrossRefPubMed

48.

Walther-Larsen S, Pedersen MT, Friis SM, Aagaard GB, Rømsing J, Jeppesen EM, et al. Pain prevalence in hospitalized children: a prospective cross-sectional survey in four Danish university hospitals. Acta Anaesthesiol Scand. 2017;61:328–37. https://doi.org/10.1111/aas.12846.CrossRefPubMed

49.

McMurtry CM, Pillai Riddell R, Taddio A, Racine N, Asmundson GJG, Noel M, et al. Far From “Just a Poke”. Clin J Pain. 2015;31:S3–11. https://doi.org/10.1097/AJP.0000000000000272.CrossRefPubMedPubMedCentral

50.

Noel M, Rabbitts JA, Fales J, Chorney J, Palermo TM. The influence of pain memories on children’s and adolescents’ post-surgical pain experience: a longitudinal dyadic analysis. Health Psychol. 2017;36:987–95. https://doi.org/10.1037/hea0000530.CrossRefPubMedPubMedCentral

51.

Shave K, Ali S, Scott SD, Hartling L. Procedural pain in children: a qualitative study of caregiver experiences and information needs. BMC Pediatr. 2018;18:324. https://doi.org/10.1186/s12887-018-1300-y.CrossRefPubMedPubMedCentral

52.

Campbell JN. The fifth vital sign revisited. Pain. 2016;157:3–4. https://doi.org/10.1097/j.pain.0000000000000413.CrossRefPubMed

53.

Scher C, Meador L, Van Cleave JH, Reid MC. Moving beyond pain as the fifth vital sign and patient satisfaction scores to improve pain care in the 21st century. Pain Manag Nurs. 2018;19:125–9. https://doi.org/10.1016/j.pmn.2017.10.010.CrossRefPubMed

54.

Smeland AH, Twycross A, Lundeberg S, Rustøen T. Nurses’ knowledge, attitudes and clinical practice in pediatric postoperative pain management. Pain Manag Nurs. 2018;19:585–98. https://doi.org/10.1016/j.pmn.2018.04.006.CrossRefPubMed

55.

Fry M, Chenoweth L, MacGregor C, Arendts G. Emergency nurses perceptions of the role of family/carers in caring for cognitively impaired older persons in pain: a descriptive qualitative study. Int J Nurs Stud. 2015;52:1323–31. https://doi.org/10.1016/j.ijnurstu.2015.04.013.CrossRefPubMed

56.

Anand KJS, Stevens BJ, McGrath PJ. Pain in neonates and infants. Edinburgh: Elsevier; 2007.

57.

Laures E, LaFond C, Hanrahan K, Pierce N, Min H, McCarthy AM. Pain assessment practices in the pediatric intensive care unit. J Pediatr Nurs. 2019;48:55–62. https://doi.org/10.1016/j.pedn.2019.07.005.CrossRefPubMed

58.

Cohen LL, Lemanek K, Blount RL, Dahlquist LM, Lim CS, Palermo TM, et al. Evidence-based assessment of pediatric pain. J Pediatr Psychol. 2008;33:939–55. https://doi.org/10.1093/jpepsy/jsm103.CrossRefPubMed

59.

Harrison D, Loughnan P, Manias E, Johnston L. Utilization of analgesics, sedatives, and pain scores in infants with a prolonged hospitalization: a prospective descriptive cohort study. Int J Nurs Stud. 2009;46:624–32. https://doi.org/10.1016/j.ijnurstu.2008.11.001.CrossRefPubMed

60.

Stevens BJ, Harrison D, Rashotte J, Yamada J, Abbott LK, Coburn G, et al. Pain assessment and intensity in hospitalized children in Canada. J Pain. 2012;13:857–65. https://doi.org/10.1016/j.jpain.2012.05.010.CrossRefPubMed

61.

Matula ST, Polomano RC, Irving SY. The state of the science in paediatric pain management practices in low-middle income countries: an integrative review. Int J Nurs Pract. 2018;24:e12695. https://doi.org/10.1111/ijn.12695.CrossRefPubMed

62.

Clancy MA. Difficulty, despair and hope – an insight into the world of the health professionals treating paediatric pain in sub-Saharan Africa. J Res Nurs. 2014;19:191–210. https://doi.org/10.1177/1744987113486472.CrossRef

63.

Levy DM, Imundo LF. Nonsteroidal anti-inflammatory drugs: a survey of practices and concerns of pediatric medical and surgical specialists and a summary of available safety data. Pediatr Rheumatol. 2010;8:7. https://doi.org/10.1186/1546-0096-8-7.CrossRef

64.

Chiaretti A, Pierri F, Valentini P, Russo I, Gargiullo L, Riccardi R. Current practice and recent advances in pediatric pain management. Eur Rev Med Pharmacol Sci. 2013;17(1):112-26.

65.

Forgeron PA, Jongudomkarn D, Evans J, Finley GA, Thienthong S, Siripul P, et al. Children’s pain assessment in northeastern Thailand: perspectives of health professionals. Qual Health Res. 2009;19:71–81. https://doi.org/10.1177/1049732308327242.CrossRefPubMed

66.

Dongara ARR, Nimbalkar SMM, Phatak AGG, Patel DVV, Nimbalkar ASS. An educational intervention to improve nurses’ understanding of pain in children in Western India. Pain Manag Nurs. 2017;18:24–32. https://doi.org/10.1016/j.pmn.2016.10.003.CrossRefPubMed

67.

White PF. Multimodal analgesia: its role in preventing postoperative pain. Curr Opin Investig Drugs . 2008;9:76–82. http://www.ncbi.nlm.nih.gov/pubmed/18183534. Accessed 12 Dec 2019.

68.

Kraemer FW. Treatment of acute pediatric pain. Semin Pediatr Neurol. 2010;17:268–74. https://doi.org/10.1016/j.spen.2010.10.010.CrossRefPubMed

69.

Kaheni S, Sadegh Rezai M, Bagheri-Nesami M, Goudarzian AH. The effect of distraction technique on the pain of dressing change among 3–6 year-old Cchildren. Int J Pediatr. 2016;4:1603–10. https://doi.org/10.22038/IJP.2016.6699.CrossRef

70.

Sahiner NC, Bal MD. The effects of three different distraction methods on pain and anxiety in children. J Child Health Care. 2016;20:277–85. https://doi.org/10.1177/1367493515587062.CrossRefPubMed

71.

Sadeghi T, Mohammadi N, Shamshiri M, Bagherzadeh R, Hossinkhani N. Effect of distraction on children’s pain during intravenous catheter insertion. J Spec Pediatr Nurs. 2013;18:109–14. https://doi.org/10.1111/jspn.12018.CrossRefPubMed

72.

Kassab M, Sheehy A, King M, Fowler C, Foureur M. A double-blind randomised controlled trial of 25% oral glucose for pain relief in 2-month old infants undergoing immunisation. Int J Nurs Stud. 2012;49:249–56. https://doi.org/10.1016/j.ijnurstu.2011.09.013.CrossRefPubMed

73.

Ozdemir FK, Tüfekci FG. The effect of using musical mobiles on reducing pain in infants during vaccination. J Res Med Sci. 2012;17:662–7 http://www.ncbi.nlm.nih.gov/pubmed/23798927. Accessed 12 Dec 2019.PubMedPubMedCentral

74.

Wren A, Ross A, D’Souza G, Almgren C, Feinstein A, Marshall A, et al. Multidisciplinary pain management for pediatric patients with acute and chronic pain: a foundational treatment approach when prescribing opioids. Children. 2019;6:33. https://doi.org/10.3390/children6020033.CrossRefPubMedCentral

75.

Sieger M, Fritz E, Them C. In discourse: Bourdieu’s theory of practice and habitus in the context of a communication-oriented nursing interaction model. J Adv Nurs. 2012;68:480–9. https://doi.org/10.1111/j.1365-2648.2011.05783.x.CrossRefPubMed

76.

Ozcetin M, Suren M, Karaaslan E, Colak E, Kaya Z, Guner O. Effects of parent’s presence on pain tolerance in children during venipuncture: a randomised controlled trial. Hong Kong J Paediatr. 2011;16:247–52 http://www.hkjpaed.org/details.asp?id=805&show=1234. Accessed 11 Dec 2019.

77.

Huggins A, Rahman MM, Claudio D, Torma LM. Balancing nurses’ workload to enhance the quality of care in an outpatient cancer clinic. Int J Collab Enterp. 2014;4(1/2):34. https://doi.org/10.1504/IJCENT.2014.065045.CrossRef

Title: Dynamics on the field: a focused study on the culture and context of pediatric pain management at four Ghanaian hospitals
Authors: Abigail Kusi Amponsah
Evans Oduro
Victoria Bam
Joana Kyei-Dompim
Collins Kwadwo Ahoto
Anna Axelin
Publication date: 01-12-2020
Publisher: BioMed Central
Published in: BMC Pediatrics / Issue 1/2020
Electronic ISSN: 1471-2431
DOI: https://doi.org/10.1186/s12887-020-02399-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Dynamics on the field: a focused study on the culture and context of pediatric pain management at four Ghanaian hospitals

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2020

Plastic bronchitis associated with adenovirus serotype 7 in children

The Association of Oral Health Status, demographic characteristics and socioeconomic determinants with Oral health-related quality of life among children: a systematic review and Meta-analysis

Protocol for the development and validation procedure of the managing the link and strengthening transition from child to adult mental health care (MILESTONE) suite of measures

Determinants of adverse birth outcome in Tigrai region, North Ethiopia: Hospital-based case-control study

Investigating and managing neonatal seizures in the UK: an explanatory sequential mixed methods approach

A case of severe malnutrition infant with neonatal onset intractable diarrhea