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Published on: January 27, 2010
Nurse-Led Intervention to Reduce Parental Anxiety and Child Pain During Non-Therapeutic Male Circumcision: A
Lyudmyla Andrusenko-Kalchenko1, Angel Romero-Collado2,3, David Ballester-Ferrando2
1Clínica Girona, Girona, Spain.
Insights
A nurse-led intervention effectively reduced child pain during non-therapeutic male circumcision. While parental anxiety was not significantly lowered, the intervention improved pain management and caregiver readiness for home care.
Area of Science:
- Pediatric Nursing
- Pain Management
- Surgical Procedures
Background:
- Non-therapeutic male circumcision is a common outpatient procedure with significant physical and emotional impacts on children and families.
- Parental anxiety and child pain are key concerns during this procedure, necessitating effective management strategies.
Purpose of the Study:
- To evaluate a nurse-led intervention's effectiveness in mitigating parental anxiety and child pain during non-therapeutic male circumcision.
- To assess the intervention's impact on postoperative pain and caregiver-reported difficulties.
Main Methods:
- An open-label, randomized trial involved 192 children (0-3 years) and 314 family members, comparing a nurse-led intervention to standard care.
- The intervention included preoperative education, guided non-pharmacological pain relief, and structured follow-up.
- Primary outcomes were parental anxiety (Hamilton Anxiety Rating Scale) and immediate child pain (Face, Legs, Activity, Cry, Consolability tool).
Main Results:
- The nurse-led intervention significantly reduced immediate postoperative child pain (mean FLACC 0.72 vs. 1.39) and increased the proportion of pain-free children (55.4% vs. 32.6%).
- Pain at 24-48 hours and caregiver-reported home care difficulties were also reduced in the intervention group.
- No significant differences in baseline parental anxiety or complication rates were observed between groups.
Conclusions:
- A structured, nurse-led intervention, incorporating non-pharmacological strategies, effectively improves pediatric pain outcomes and caregiver preparedness following non-therapeutic male circumcision.
- While parental anxiety reduction was not statistically significant, the intervention offers a valuable approach to enhance pain management and support families in this setting.
Introduction:
Non-therapeutic male circumcision is often performed in outpatient settings and has physical and emotional implications for children and families.
Objective:
To evaluate the effectiveness of a nurse-led intervention in reducing parental anxiety and child pain during non-therapeutic male circumcision.
Methods:
An open-label, parallel-group, randomized trial was conducted at Policlínica Maresme (Spain) for review between March and May 2022. A total of 314 family members and 192 children aged 0 to 3 years were randomly assigned (1:1) to either a nurse-led intervention or standard care. The intervention included a face-to face preoperative educational session, guided use of non-pharmacological pain relief techniques during surgery, and structured postoperative follow-up. The control group received routine care comprising written postoperative instructions and follow-up calls. Primary outcomes were preoperative parental anxiety, assessed using the Hamilton Anxiety Rating Scale (HAM-A), and immediate postoperative child pain, measured with the Face, Legs, Activity, Cry, Consolability (FLACC) tool. Secondary outcomes included pain at 24 to 48 hours and 8 to 10 days, caregiver-reported home care difficulties, and complication rates.
Results:
Baseline parental anxiety did not differ between groups (mean difference -0.29; 95% confidence interval [CI] -2.22 to 1.64). Children in the intervention group had significantly lower postoperative pain (mean FLACC 0.72 vs. 1.39; mean difference -0.66; 95% CI -0.98 to -0.35) and were more often pain-free (55.4% vs. 32.6%; odds ratio [OR] 2.55; 95% CI 1.42-4.59). Pain at 24 to 48 hours and caregiver-reported difficulties were also reduced. No group differences were found in complication rates.
Conclusion:
The nurse-led intervention improved children's pain outcomes and caregiver preparedness for home care, although it did not significantly reduce parental anxiety. Structured, nurse-led education combined with non-pharmacological strategies can enhance pediatric pain management and caregiver preparedness, particularly in healthcare settings where non-therapeutic male circumcision is performed for cultural or religious reasons.
Trial Registration:
ClinicalTrials.gov: NCT05387291.
