Abstract
This paper evaluates the effects of an educational pain programme for nurses and paediatricians in a Taiwanese hospital. First, it builds on recent work that clearly identifies separate but related findings in terms of inadequate physician and nurse pain knowledge regarding paediatric pain management in Taiwan. The focus of the study was to deliver an educational intervention related to paediatric pain and symptom management to physicians and nurses, using a pre- and posttest design. To evaluate the intervention, the chosen measures were confidence and attitudes. Moving the research beyond solely the acquisition of knowledge to include concepts such as confidence is refreshing and provides a more nuanced approach. It also fits well with the interprofessional context of managing pain in which nurses may possess the knowledge but may lack confidence about approaching a physician, for example, when requesting a review of a prescribed analgesic. It would have been interesting to know why they selected confidence, how the authors felt this might be applied in the clinical setting and what changes in paediatric pain management they might expect to see.
It was evident that the 5 hours of teaching included a variety of teaching methods, beyond the didactic, and perhaps touched upon interprofessional learning. Did participants have an opportunity to understand each other’s roles and perspectives and learn from each other? We do not know why other members of the healthcare team who could impact on patients’ experience of pain – such as pharmacists – were not included in the initiative, but they might have enriched the learning process. The use of panel discussions and video clips can often provoke rich discussions. It would have been interesting to know more about how these individuals felt about learning together and what they would transfer into the clinical arena, perhaps by following up with interviews at a later date. The authors mention that opportunities to learn together will be part of the future training initiatives but do not elaborate on this. The opportunity to discuss barriers that impede the effective delivery of pain management will be essential if the care of these paediatric patients is to improve.
The authors suggest that the sample size may have been too small to detect changes in attitudes. While this is potentially a limitation, it is notable that they achieved a response rate of 80%, including both paediatricians and nurses. The creation of a new measure to capture the change in attitudes, albeit a composite of others, is always a challenge. The process of achieving reliability and validity was described, but the instrument is at an early stage and therefore confidence in the measure might be undermined.
We are given little understanding of the context and bigger picture of paediatric palliative care and the norms in Taiwan. For example, what is the provision for those paediatric palliative care patients receiving care in the community? Is hospital care where the majority of palliative care takes place? A recent study in the UK reported that many palliative care patients in the community do not receive opioids until the final trajectory of their disease, usually just 9 weeks before they die (Ziegler et al., 2016). The study highlighted the disparity between the onset of pain and the instigation of opioids, with the authors suggesting that more community-based approaches for the assessment and management of cancer pain are required. This current research is a welcome contribution to the topic, particularly in terms of the provision of pain and symptom management for Taiwanese paediatric palliative care patients in hospital. As well as providing a platform for further research, it might also begin to question the provision of palliative care paediatric pain management prior to hospitalisation.