31 The Parental Process of Appraising Child Pain: An International Qualitative Study

Pain is a common experience among children and infants in clinical settings worldwide. Nurses often depend upon parents to aid in assessment of pain. Yet, the unique parent's processes of appraising pain are not fully known. The purpose of this study was to explore the social process of parent appraisal of child and infant pain and to examine cultural influences upon this appraisal. A qualitative design with grounded theory method was used to guide data collection and analysis in the larger international study. Settings were two acute care clinical sites, one in Rome, Italy and one at a large Midwestern tertiary hospital in the USA. This paper reports on findings from the Italian sample of 12 parents of children hospitalized in three units (the cardiac surgical intensive care, the neonatal intensive care unit and the oncology-emathology unit). Data were drawn from semi-structured interviews and bedside observations of parent-child interactions. A constant comparative data analysis approach resulted in coding of text and observation data, thematic naming, comparison of differences and commonalities between participants, and re-assembling of the themes. The core process of parent appraisal of pain was identified as “struggling to understand the hurdle of pain while protecting the child” Parents described a process of comparing, observing, grading, and rationalizing in their struggle to understand child pain. Unique cultural values and beliefs influenced the parent's depth of involvement in the appraisal process. Parent sense of success in protecting the child was interwoven with the relationship with the provider.