Pain assessment of children under five years in a primary health care setting

Abstract

Pain is a very common problem experienced by the general population and children in particular. It goes beyond personal suffering and affects all dimensions of the quality of life and general functioning of both adults and children, be it the physiological, psychological or financial aspects. Children may suffer from pain that may either be chronic or acute, depending on the diagnosis. Assessment of pain in children is equally important as that of adults, except that they lack the verbal fluency and cognitive development to communicate their pain. Children’s experience of pain is similar to that of adults. Pain assessment is a key aspect in the nursing management of children and delivery of care within the Primary Health Care (PHC) setting. Effective pain assessment is thus reliant on comprehensive assessment of the child and his or her pain. The aim of this research was to explore and describe practices and perceptions of professional nurses working in a PHC facility regarding pain assessment of children under five years in the Mangaung Metropolitan Municipality and to formulate recommendations for professional nurses in PHC facilities to facilitate pain assessment in PHC settings. A qualitative study design was used and data was collected with the use of focus groups. A purposive sampling was conducted to select participants who represent the target population. The sample used for the study included all the professional nurses working in PHC facilities registered with the South African Nursing Council and that have at least one year of experience. The practical training of the researcher to conduct an interview was done prior to the actual research. A pilot focus group was conducted and the interview schedule was finalised. Semi-structured focus groups were used to obtain data from the participants. The researcher conducted 6 focus group interviews attended by 32 professional nurses. Data was collected until data saturation was achieved. Trustworthiness was ensured in accordance with the principles of credibility, transferability, dependability and confirmability. Data was captured on a digital voice recorder and transcribed verbatim. Field notes were taken during each focus group. Data analysis was done by means of content analysis by the researcher and an independent co-coder. After consensus and saturation, three major themes emerged. Each theme was identified and divided into sub-themes and was consequently discussed together with the relevant data obtained from literature. The findings indicated that professional nurses perceive the assessment of pain in children under five years as a challenge. The combination of signs and symptoms to make decisions with pain assessment was identified as an area of concern. The participants further p erceived the history provided by the parent as important in the process of pain assessment. The conclusions drawn are that the professional nurses acknowledge that they don’t take sufficient notice of pain in children under five, which means that children with pain are neglected. Professional nurses maintain that there is a need for sufficient pain assessment and the need for guidelines and tools to assess pain in children under five, especially in the PHC setting. These professional nurses support the availability of guidelines to assist them to conduct effective and comprehensive pain assessment. The research report concluded with the researcher’s recommendations for nursing education, nursing research and nursing practice with specific formulation of guidelines for the facilitation of professional nurses to truly render effective and comprehensive pain assessment in PHC settings.