Hospitalized children as social actors in the assessment and management of their pain

• Main Author: Kortesluoma, R.-L. (Riitta-Liisa)
• Format: Doctoral Thesis
• Language: English
• Published: University of Oulu 2009
• Subjects: Draw-A-Person procedure; child; pain experience; qualitative interview; thematic drawing
• Online Access: http://urn.fi/urn:isbn:9789514292880; http://nbn-resolving.de/urn:isbn:9789514292880

Abstract By acknowledging pain as subjective and only fully perceived by the person in pain, the main aim of this study was to report on the use of qualitative child interviewing and drawings as a research method to elicit hospitalized children’s perceptions and descriptions of their pain experience. Further, the second aim was to contribute to the improvement of pain assessment and management in hospitalized children by approaching the question from the children’s point of view through their words and drawings. Forty-four children in four paediatric units in a university hospital participated in the study. The data were collected by means of qualitative interviews and thematic drawings. The interview data were analysed using inductive content analysis. The drawings were sorted into categories on the basis of contents, and cognitive competence and emotional disturbances by the Draw-A-Person procedure, and a comparison was made of the data from hospitalized children and healthy control groups. All the children had experienced pain in different situations while hospitalized. The pain experiences came from four main sources: 1. pain caused by a diagnosed basic illness, 2. pain caused by medical and diagnostic procedures and basic nursing, 3. pain caused by accidents, and 4. inexplicable pain not caused by a particular illness or injury and imaginary pain. In describing their pain, the children emphasized the multidimensional nature of pain and used a number of self-reported pain words to describe physical and psychic pain, as well as evaluative aspects of pain. The children had difficulties in finding positive aspects about pain. The drawings of the hospitalized children frequently depicted medical procedures, whereas the drawings of the healthy controls depicted more family relations. The hospitalized children showed a lower level of cognitive capacity, whereas the healthy control group children revealed a higher level of emotional disturbance. The variety of children’s responses to pain management suggests that children try and can alleviate their pain. The children reported their expectations of professional help and valued the care and attention provided by significant others. The findings provide research-based knowledge for carrying out research with children, and for healthcare professionals in their assessment and management of children’s pain in more holistic and child-centred way. Children’s competence to describe their pain supports encouraging their involvement as social actors in pain assessment and management in partnership with health care professionals and significant others. This has to be done with respect for their rights as individuals and the desire to give them a sense of ownership of what happens during hospitalization.