Date of Award

2019

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Graduate Group

Nursing

First Advisor

Rosemary C. Polomano

Second Advisor

Sharon Y. Irving

Abstract

ABSTRACT

PEDIATRIC ACUTE PAIN MANAGEMENT PRACTICES IN BOTSWANA

Samuel T. Matula

Rosemary C. Polomano, Ph.D., RN, FAAN

Sharon Y. Irving, Ph.D., RN, FAAN

Pediatric acute pain is a serious global health issue and remains unexplored mainly in low and middle-income countries (LMIC). Children in LMIC are at high risk to suffer from inadequately managed acute pain, but it is challenging to quantify the magnitude of the problem, evaluate resource availability for acute pain management, and address possible factors influencing acute pain recognition, assessment and treatment. Pediatric acute pain management is complex, if not adequately managed could lead to life-long consequences. Therefore, the purpose of this dissertation is to examine pediatric acute pain management practices in Botswana. Using a three-article format, this dissertation in Chapter 2 presents a synthesis of existing literature to describe the state of the science of pain management practices in LMIC. Chapter 3 reports on pain prevalence, intensity and nature, and pain management practices in Botswana using observational data and a retrospective review of hospital health records. In Chapter 4, children's and parents/guardians’ experiences and perceptions of pediatric pain management practices in Botswana are explored through a convergent mixed-method design, integrating data from a descriptive cross-sectional survey and descriptive qualitative study. The principle findings were: 1) critical gaps and limitations exist in the available literature, particularly in sub-Saharan Africa; 2) resource availability, children and parents/guardians’ voices are mostly absent in literature, and healthcare providers are not prepared to adequately deal with pediatric pain; 3) visible efforts are evident in the development and validation pain tools and novel treatment strategies, but not in clinical applications; 4) acute pain prevalence is high among hospitalized children, and acetaminophen is the drug of choice, despite a substantial proportion of children having moderate-severe pain; 5) reports of severe pain are rare and maximum pain intensity documented in health records is moderate pain; 6) pain assessment was not well documented; 7) children and parents/guardians were content with pain care, but expect adequate acute pain treatment and child comfort; and 8) children and parents/guardians demonstrate significant understanding of pediatric acute pain, child risk factors, consequences, and management strategies. Pediatric acute pain is a significant problem in Botswana and requires a comprehensive strategy to improve its management.

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