This project is designed to compare two nursing action protocols with standard nursing practice in a children's hospital to determine the effect of the experimental protocols on intensity of postoperative pain. A modified randomized blocks design with repeated measures will be used to address the following research questions: (1) Are theoretically based nursing action protocols more effective in alleviating postoperative pain in young children than standard nursing practice?; (2) Do two theoretically based nursing action protocols, one focused on activation of central pain control mechanisms, the other focused on activation of peripheral pain control mechanisms, differ in their effectiveness in alleviating pain in young children?; (3) Are there interactions between type of nursing action and age, ethnicity, and/or surgical procedure?; and (4) What patterns of postoperative pain intensity are evident in the overall sample and in subgroups within the sample? Nursing action protocols were developed from Orem's nursing theory, gate control pain theory, pain management studies, and empirical data from current practice. Subjects will be 300, 3 to 7 year old African-American, Hispanic, and European-American children who undergo surgical procedures. Children will be assigned randomly to two treatment (protocol) groups, blocking on surgical procedure, age, and ethnicity. Children in the first group will receive care according to a protocol of nursing actions focused on activation of central pain control mechanisms. The protocol for the second group will be comprised of actions focused on activation of peripheral pain control mechanisms. Baseline data on postoperative pain intensity levels with standard nursing practice will be obtained for a control group of children drawn from the same population prior to implementation of the experimental treatment protocols. Nurse and child reported measures of pain intensity will be obtained at hourly intervals from 1 to 12 hours postoperatively. Analysis of variance using two contrasts will be used to determine the main effects of the two protocols, the blocking variables, and their two way interactions on average level of pain intensity over time. Mixed design analysis of variance with trends will be used to evaluate patterns of pain intensity over time. The fact that young hospitalized children experience pain has been documented, yet virtually no carefully designed research on nursing care to alleviate pain has been reported. The proposed study seeks to address this major gap in knowledge.
