An Innovative Assessment of Adult Influences on Children's Postoperative Pain

成人对儿童术后疼痛影响的创新评估

• 批准号: 7684798
• 负责人: Zeev Kain
• 金额: $ 15.6万
• 依托单位: UNIVERSITY OF CALIFORNIA-IRVINE
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-10 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7684798
• 关键词: Address; Adoption; Adult; Age; Anesthesia procedures; Anxiety; Attention; Behavior; Behavioral; Caring; Certified registered nurse anesthetist; Characteristics; Child; Child Behavior; Child health care; Childhood; Complex; Data; Development; Distress; Educational process of instructing; Emotional; Environment; Evaluation; Event; Exposure to; Fright; Future; Gender; Health Personnel; Healthcare; Home environment; Hospitals; Immunization; Intervention; Joint Commission on Accreditation of Healthcare Organizations; Knowledge; Lead; Link; Medical; Methods; Nociception; Non-Steroidal Anti-Inflammatory Agents; Nurses; Operative Surgical Procedures; Opioid; Pain; Pain management; Parenting behavior; Parents; Pattern; Perioperative; Pharmaceutical Preparations; Physical environment; Physiological; Postoperative Pain; Postoperative Period; Preparation; Primary Health Care; Procedures; Process; Reporting; Research; Spinal Puncture; Surgeon; System; Techniques; Temperament; Tissues; Training; Training Programs; Translations; United States; behavior change; behavior influence; clinically significant; coping; cost; distraction; effective intervention; evidence base; experience; innovation; parental influence; premature; programs; psychologic; public health relevance; response; social; statistics; therapy development; Address; Adoption; Adult; Age; Anesthesia procedures; Anxiety; Attention; Behavior; Behavioral; Caring; Certified registered nurse anesthetist; Characteristics; Child; Child Behavior; Child health care; Childhood; Complex; Data; Development; Distress; Educational process of instructing; Emotional; Environment; Evaluation; Event; Exposure to; Fright; Future; Gender; Health Personnel; Healthcare; Home environment; Hospitals; Immunization; Intervention; Joint Commission on Accreditation of Healthcare Organizations; Knowledge; Lead; Link; Medical; Methods; Nociception; Non-Steroidal Anti-Inflammatory Agents; Nurses; Operative Surgical Procedures; Opioid; Pain; Pain management; Parenting behavior; Parents; Pattern; Perioperative; Pharmaceutical Preparations; Physical environment; Physiological; Postoperative Pain; Postoperative Period; Preparation; Primary Health Care; Procedures; Process; Reporting; Research; Spinal Puncture; Surgeon; System; Techniques; Temperament; Tissues; Training; Training Programs; Translations; United States; behavior change; behavior influence; clinically significant; coping; cost; distraction; effective intervention; evidence base; experience; innovation; parental influence; premature; programs; psychologic; public health relevance; response; social; statistics; therapy development

DESCRIPTION (provided by applicant): Over five million children undergo surgery in the United States each year and, despite recent advances, pain in children following surgery continues to be a significant problem. It is reported that up to 49% of children suffer clinically significant pain while in hospital and this pain is overwhelmingly under treated. Pharmacological methods such as opioids and non-steroidal anti-inflammatory agents are generally considered the first line of postoperative pain management. It is well documented, however, that pain is a complex, multidimensional condition that can not be optimally treated by medication alone. Instead, it is necessary to attend to nonpharmacological methods of addressing pain. Changing behaviors of healthcare personnel and parents in response to children's pain has been an effective intervention in procedural pain settings (e.g., immunizations), but little is known about the relations between adult behavior and children's pain in postoperative settings. There are distinct differences between the procedural and postoperative environments that undoubtedly influence the relations between adult behaviors and children's pain. For example, postoperative pain is of a longer duration than procedural pain and parents and children generally have less experience in perioperative environments than in primary care. To develop effective interventions that address adult behavior, it is of utmost importance to first empirically identify the specific parent and health-care personnel behaviors that increase or decrease children's postoperative pain. This will be achieved by obtaining a postoperative sequential process-oriented view of parent-child-health care provider behavioral interactions and by using robust sequential analysis techniques. Primary aims of the study are to identify specific parent and healthcare provider behaviors that influence children's postoperative pain. As a secondary aim, we will identify child characteristics (e.g., age) that may moderate the influence of parent and healthcare provider behaviors on children's postoperative pain. Identification of behavioral interaction patterns that influence children's postoperative pain will facilitate the development and evaluation of evidence-based training programs for parents and healthcare providers' in postoperative pain management. PUBLIC HEALTH RELEVANCE: At the conclusion of the study described in this application, we will have identified specific parental and healthcare provider behaviors that are associated with increased or decreased pain immediately following surgery and at home. This information will allow us to develop data-driven behavioral preparation programs that will teach parents, nurses, anesthesiologists and surgeons in how to reduce children's pain in the postoperative process. This newly developed, low-cost, parental and healthcare provider preparation program can be widely adaptable to nearly any medical facility in the United States.

描述（由申请人提供）：每年在美国接受手术超过500万儿童，尽管最近进展，手术后的儿童疼痛仍然是一个重大问题。据报道，在医院期间，多达49％的儿童在临床上疼痛，这种疼痛受到压倒性的治疗。药理学方法，例如阿片类药物和非甾体类抗炎药通常被认为是术后疼痛管理的第一线。然而，有充分的文献证明，疼痛是一种复杂的多维疾病，不能仅通过药物来最佳治疗。取而代之的是，有必要参加解决疼痛的非药理方法。医疗保健人员和父母对儿童疼痛的改变行为一直是对程序性疼痛环境（例如免疫接种）的有效干预，但对成人行为与术后儿童疼痛之间的关系知之甚少。程序和术后环境之间存在明显的差异，这些环境无疑会影响成人行为与儿童痛苦之间的关系。例如，术后疼痛的持续时间比程序性疼痛更长，父母和孩子在围手术期环境中的经验通常比初级保健的经验更少。为了制定有效的干预措施来解决成人行为，首先从经验上确定特定的父母和医疗保健人员行为至关重要，从而增加或减轻儿童术后疼痛。这将通过获得亲子卫生护理提供者行为相互作用并使用可靠的顺序分析技术的术后顺序序列过程的视图来实现这一目标。该研究的主要目的是确定影响儿童术后疼痛的特定父母和医疗保健提供者行为。作为次要目标，我们将确定可能调节父母和医疗保健提供者行为对儿童术后疼痛的影响的儿童特征（例如年龄）。识别影响儿童术后疼痛的行为互动模式将有助于为父母和医疗保健提供者的循证培训计划的开发和评估。 公共卫生相关性：在本申请中描述的研究结束时，我们将确定特定的父母和医疗保健提供者的行为，这些行为与手术后和家里立即增加或减轻疼痛有关。这些信息将使我们能够制定以数据为导向的行为准备计划，这些计划将教会父母，护士，麻醉学家和外科医生如何在术后如何减轻儿童的疼痛。这个新开发的，低成本，父母和医疗保健提供者准备计划可以广泛适应美国的任何医疗机构。