Primer on adult patient satisfaction in perioperative settings.

The topic of patient satisfaction has gained increasing importance over the past decade. Due to the impact of patient satisfaction on health care quality, understanding factors that predict satisfaction is vital. The purpose of this review is to examine the literature and identify factors related to patient perioperative satisfaction as well as predictive variables that, if modified, can enhance satisfaction scores of patients undergoing surgery. Our review reports that patient satisfaction scores are affected by modifiable factors such as clinician-patient communication, information provision to patients, and operational function of a hospital. Non-modifiable factors affecting patient satisfaction scores include patient demographics such as gender, age, and education. In order to enhance patient perioperative satisfaction, we suggest that anesthesiologists and surgeons focus their efforts on enhancing their communication skills and providing information that is appropriately tailored to the understanding of their patients

Applying Theoretical Models of Positive Emotion to Improve Pediatric Asthma: A Positive Psychology Approach

Positive emotion, encompassing feelings such as joy and happiness, has been shown to predict a multitude of health outcomes. However, the role of positive emotion in pediatric asthma is not understood. No work to date has examined how positive emotion may offer benefits to children and adolescents with asthma. Based on theory and models of positive emotion and health, we hypothesize that positive emotion may improve asthma outcomes through mediators such as health behaviors and health-relevant physiological functioning. Moreover, boosting positive emotion during times of stress may be particularly relevant in mitigating asthma symptoms. In the present commentary, we elaborate on the hypothesized mechanisms behind such associations grounded within positive emotion theoretical frameworks. Additionally, we summarize the methodologically rigorous work of positive emotion interventions in other clinical settings to propose that positive emotion could be a useful tool in the management of pediatric asthma

Sex as a Moderator in the Relationship between Post-operative Pain and Analgesics Administered in Children Undergoing Elective Surgery

About 85% of children who undergo elective surgery experience pain post-operatively and many do not receive proper pain management care after discharge. Most parents lack an understanding of proper pain care management using analgesics upon discharge. Research reveals that adults rate girls as more sensitive to pain and that they display a greater amount of pain in a pediatric post-operative environment. In adulthood, women report more sensations of pain and have a higher pain tolerance, which can be attributed to physiological characteristics. Nonetheless, the social differences by which boys and girls experience pain and express their pain cannot be denied. The purpose of this study is to understand the relationship between a child’s post-operative pain and the amount of analgesics given to the child, and how sex moderates this association. Parents of children ages 2-13 (59% male, 41% female) (N=112) were asked to evaluate the pain of their child and report the amount and type of analgesic use days 1, 3, and 7 post-operatively. The Parents Perceived Pain Management (PPPM) Scale was used to evaluate the child’s pain and analgesic use was self-reported. Using this scale in regression-based analysis, there was a significant association between pain and the amount of analgesic use given to the children on post-operative days 1 (ibuprofen: b = 0.24, t = 3.55, p \u3c 0.05, acetaminophen: b = 0.22, t = 5.38, p \u3c 0.05) and 3 (ibuprofen: b = 0.72, t = 4.81, p \u3c 0.05, acetaminophen: b = 0.34, t = 4.44, p \u3c 0.05); however; sex did not significantly moderate this association (ps \u3e .05). Evidence in this study does not suggest that boys receive different post-operative analgesic care from girls as a function of pain. Future analysis should analyze factors that interact with this association like the sex of the parent that is administering analgesics and the parent’s education of analgesic usage

Pediatric Postoperative Pain Medication: Child Sex and Ethnicity Interact to Predict Parent Medication Attitudes

Over 85% of children experience significant pain after surgery. Despite this presence of pain, research suggests that a quarter of these children receive very little or even no pain medication at home. Such poor pain management in children can have harmful long-term consequences, both physically and psychologically. Previous research indicates that the amount of pain medication administered to children in the home may be significantly impacted by beliefs and attitudes parents have regarding analgesics. Given this, the purpose of the present study is to identify which demographic factors are associated with certain parent analgesic attitudes or misconceptions among pediatric patients ages 2-13 who have undergone elective surgery at the Children’s Hospital of Orange County (N = 112). Prior to surgery, parents completed surveys to report demographics and medication attitudes—fear of side effects, avoidance, and appropriate use attitude. Ethnicity was found to interact with child sex to predict parents’ fear of side effects, b = -4.750, p = 0.043. Specifically, among Hispanic households, parents of daughters expressed a greater fear of side effects from analgesics compared to parents of sons. The opposite trend was seen in White households, such that parents of sons expressed a greater fear of side effects compared to parents of daughters. This sex difference in Hispanic families may be due to the phenomenon machismo, a term characterized by the hypermasculine idealization of men. Specifically, Hispanic parents may express a significantly lower fear of side effects for their male children because they are encouraging their sons to be more stoic and “tough.” The hypermasculinity principles behind machismo, however, may not significantly transcend across other ethnic groups, as showcased by the opposite trend observed in White parents. These findings can be utilized to develop interventions that specifically target and educate parents who are likely to have misconceptions concerning analgesic use while still respecting the family’s culture, values, and practices

Postoperative Pain: Factors and Tools to Improve Pain Management in Children

Outpatient surgery has made it increasingly common for parents to manage pain in the home setting. Studies have shown that parents often under treat pain, leaving children vulnerable to the negative side effects of suboptimal pain management. Multiple factors affect pain management like child’s age and developmental stage, language, cultural values like stoicism, parental beliefs about medication, biological differences among groups, etc. Understanding all the factors involved can help healthcare providers and parents better understand pain and contribute to optimal pain management. Multiple tools and technological interventions have been created to help create a better understanding of pain and a holistic approach to care

Development of a Short Version of the Modified Yale Preoperative Anxiety Scale

BACKGROUND: The modified Yale Preoperative Anxiety Scale (mYPAS) is the current “criterion standard” for assessing child anxiety during induction of anesthesia and has been used in \u3e100 studies. This observational instrument covers 5 items and is typically administered at 4 perioperative time points. Application of this complex instrument in busy operating room (OR) settings, however, presents a challenge. In this investigation, we examined whether the instrument could be modified and made easier to use in OR settings. METHODS: This study used qualitative methods, principal component analyses, Cronbach αs, and effect sizes to create the mYPAS-Short Form (mYPAS-SF) and reduce time points of assessment. Data were obtained from multiple patients (N = 3798; Mage = 5.63) who were recruited in previous investigations using the mYPAS over the past 15 years. RESULTS: After qualitative analysis, the “use of parent” item was eliminated due to content overlap with other items. The reduced item set accounted for 82% or more of the variance in child anxiety and produced the Cronbach α of at least 0.92. To reduce the number of time points of assessment, a minimum Cohen d effect size criterion of 0.48 change in mYPAS score across time points was used. This led to eliminating the walk to the OR and entrance to the OR time points. CONCLUSIONS: Reducing the mYPAS to 4 items, creating the mYPAS-SF that can be administered at 2 time points, retained the accuracy of the measure while allowing the instrument to be more easily used in clinical research settings

Postoperative Pain Management in Children of Hispanic Origin: A Descriptive Cohort Study

BACKGROUND: It has been established that pain is frequently undertreated in children following outpatient surgery. Very few studies, however, have investigated this phenomenon in ethnically diverse populations. METHODS: This study included 105 families of children aged 2 to 15 years of Hispanic origin and low income undergoing outpatient tonsillectomy and adenoidectomy surgery. Participating parents completed baseline and demographic packets. Recorded postoperative pain ratings and administration of analgesics at home for 1 week were collected during home visits. RESULTS: Despite the high (70%; 99% confidence interval [CI], 57%–82%) incidence of significant pain in the first 24 hours home, 32% (95% CI, 20%–45%) of the children received 0 to 1 dose of analgesia. Overall, 21% children (99% CI, 11%–35%) received 4 or less total doses of pain medication over the entire week after surgery. Of the total analgesic doses administered to children in the week after surgery, only 44% (99% CI, 40%–47%) were in accepted ranges. CONCLUSIONS: Despite experiencing significant postoperative pain, Hispanic children assessed in this study received suboptimal analgesic therapy at home

Demographic Predictors of Adult Behaviors in the Pediatric Postoperative Environment

Over 85% of children experience postoperative pain. If poorly treated, pediatric postoperative pain may lead to various negative health outcomes. Adult behaviors may be associated with child experiences in the postoperative environment. For example, adult behaviors such as distraction, humor, and coping advice divert a child’s attention away from their pain and thus, may significantly reduce child postoperative distress. In contrast, adult behaviors such as empathy, reassurance, and apology direct a child’s attention towards their pain which may increase a child’s overall postoperative distress. Moreover, patient demographic factors, like child ethnicity, may significantly alter the frequency of use of these adult behaviors. Therefore, this study aimed to determine which participant demographic factors are associated with the use of certain adult behaviors in response to child postoperative distress. This study included children ages 2 to 10 years old (N=112) undergoing elective surgery at the Children’s Hospital of Orange County. Participant demographics including ethnicity and race were collected prior to surgery. Nurse, parent, and child postoperative behavioral interactions were video recorded in the Post Anesthesia Care Unit (PACU). From these video recordings, adult behaviors were coded for their frequency of use. Multiple regressions analyses showed that adults were more likely to use humor with Non-Hispanic White children compared to Hispanic children (b = 0.393, p = 0.049). Moreover, fathers were marginally more likely to use empathy, reassurance, and apology with Hispanic children compared to Non-Hispanic White children (b = 0.249, p = 0.05). These results suggest that Hispanic and Non-Hispanic White children may receive different behavioral treatment in response to their postoperative distress. Implications for these findings suggest that child ethnicity may be predictive of different adult PACU behaviors which may illustrate how cultural differences can influence the child postoperative experience

Stress and Negative Affect as Mediators in the Association between Parental Social Support and Lung Function in Adolescents with Asthma

Asthma is the leading chronic condition amongst children in the United States as 7.5% of children are diagnosed with asthma. Studies have shown that positive social support is associated with positive asthma management. A strong social support system predicts good management of asthma symptoms; however, current literature has not yet examined how social support impacts lung function as opposed to merely symptom management. Stress and negative affect have been revealed to be associated with worse asthma control, as well as exacerbation of symptoms. Stressful situations, such as the death of a family member, unemployment, and familial tensions lead to worsening asthma symptoms, caused by the release of hormones. Similarly, negative affect has been analyzed as a causal factor for worsening asthmatic symptoms. Therefore, this pilot study sought to assess parental social support, adolescent stress and negative affect, and adolescent biological lung function to determine whether these affective processes (negative affect and stress) might serve as mediators in the association between social support and lung function. Adolescents suffering from asthma ages 12-17 (mean age = 13.9) (n = 21) were recruited from the pediatric asthma clinic at CHOC Children’s Hospital of Orange County for this pilot study. Participants were asked to complete a baseline survey upon recruitment assessing parental social support and stress. Seven consecutive days thereafter, for 4 times a day, participants were given a spirometer and asked to record lung function values including Peak Expiratory Flow (PEF) and Forced Expiratory Volume in 1 second (FEV1) as well as negative affect emotionality. Regression analysis revealed that higher levels of parental social support were associated with lower negative affect, b = -0.44, p \u3c 0.05, and stress, b = -0.40, p \u3c 0.05. However, there was no association between parental social support and lung function, for both PEF and FEV1 values. Implications for this study suggest that children with asthma who have more social support from parents have less stress and less negative affect. Next steps in this work are to analyze these mediators again, by recruiting more participants to the present study. Research should continue to consider psychological factors on children’s asthma in hopes of improving quality of their life