Eleven experimental studies (n=1,227) were included: 3 controlled clinical trials (n=372), 2 studies described as quantitative (n=334), 3 observational or audit studies (379 children, parent and nurses combined) and 3 qualitative studies (n=142). The sample size ranged from 6 to 303.
Viewpoint of children's perspective (1 qualitative study, n=6).
This study reported that children sought support from family members, and that families provided emotional and physical support.
Viewpoint of family members (3 non-randomised controlled studies, 3 quantitative studies and 2 qualitative studies).
One qualitative study (n=129 parents) reported that parents of children undergoing day surgery were critical of instructions received from hospital staff, were unable to adhere to advice due to tiredness and hunger, and some had inadequate skills to assess or deal with their children's pain.
One quantitative study (n=303) reported that parents of children undergoing ambulatory surgery were not satisfied with instructions received from hospital staff and reported more children's pain than expected, but most felt adequately prepared for discharge. (A family definition was used as a study framework.)
One qualitative study (7 mothers) reported assessing the child's pain based on behaviour and physical signs, but they were unsure if the child's verbal report of pain could be relied upon. They reported fears about addiction. (Family theory - Mead's theory of interaction between family members - was used as a study framework).
One quantitative study (31 parents) reported that only half of the parents wanted to give the child analgesia themselves during hospitalisation.
One controlled study (180 parents) reported that children whose parent received extra preparation, support and education began to drink earlier after tonsillectomy and adenoidectomy than a control group given no additional instructions.
Two controlled studies reported that there was either no relationship between instructions and post-operative diet and children's pain (100 parents), or no differences in children's post-operative pain and activity between advice given to parents about a restricted versus an unrestricted diet (92 parents).
Viewpoint of a combination of informants (parents, children or nurses).
One observational study (129 nurses and 93 parents) reported that parents rated the children's pain higher than nurses and that some parents wanted better information about post-operative care.
One observational study (50 children and 50 parents) reported a higher rating of pain in adolescents from controlling and conflicting families.
One observational study (22 parents, 11 children and 24 nurses) reported that parents used comforting measures and nurses used technical care, parents valued children who tolerated pain, and nurses thought quiet children were good. The study also reported misconceptions about analgesic use in children in both parents and nurses, and little interaction between parents and nurses about pain management.
Family theories and definitions.
Two studies defined a 'family' or based the study on theory.