As the mother of an autistic son who is nonverbal, Phyllis Mesko, RN, knows first-hand how picture communication aids and social stories can benefit children with communication barriers. She has been using such aids with 26-year-old Mark since he was diagnosed at age 7.
As a staff nurse in Akron Children's Post Anesthesia Care Unit (PACU), she also saw the potential for adapting these aids for post-operative patients with communication and language barriers.
“When Mark was first diagnosed, I used to walk around with a Polaroid camera and take pictures to represent eat, drink, everything,” said Mesko. “I figured that if this (picture communications) helped him, it could help others too.”
Two years ago, Mesko became one of three nurses selected for the inaugural nurse scholars group.
Akron Children's Nurse Scholar Program was developed to prepare nurses to participate in the research process and translate study results into practice. Recipients receive a pediatric nursing research grant and are provided up to 400 hours to complete their project.
Aris Eliades, PhD, RN, CNS, associate director of Akron Children's Rebecca D. Considine Research Institute and director of Nursing Research, and Cheryl Libertin, MS, CPNPPC, clinical coordinator of Nursing Research, serve as mentors to the nurse scholars.
The purpose of Mesko’s study was to determine if there was inconsistency between the nurse’s assessment of the location of pain in post-op patients versus identification of the pain location using picture aids in post-op tonsillectomy and adenoidectomy patients, 3 to 9 years old.
“We also wanted to determine if parent satisfaction with the use of the picture aids was comparable to historical data on parent satisfaction with pain management,” said Mesko.
A PACU nurse reviewed the surgery schedule daily to identify participants for inclusion in the study. “A PACU nurse would complete a standard pain assessment. Patients with an anesthesia recovery score of 6 or greater would be asked to point to a picture of their pain location,” said Mesko.
Complete data was collected on 33 participants with a total of 160 complete pain assessments and 33 parent satisfaction surveys submitted.
In 38 percent of the cases when a PACU nurse documented the location of pain, there was a discrepancy with the location identified by the patient using pictures.
“The PACU nurse cited the operative site as the location of pain 81 percent of the time, compared to 20 percent by the patient,” said Mesko. “When patients used pictures, sometimes the pain location was the IV site, their belly, back or another area.”
Parents expressed satisfaction with the use of picture communication and agreed that the pictures were easy for their children to use and helped them to identify where it hurt.
“Parents also rated the nurse’s concern with their child’s comfort after surgery and the degree their child’s pain was controlled following surgery higher than national averages,” said Mesko.
This past April, Mesko presented the study results at the 30th National American Society of PeriAnesthesia Nurses Conference in Seattle.
“She was one of only four people chosen to make an oral presentation and one of 22 poster presentations,” said Dr. Eliades.
Mesko has also submitted her results for publication in the Journal of PeriAnesthesia Nursing and was recently invited to present at state and international conferences.
The process has re-energized her 41-year nursing career. “I love research. It has opened up a whole new world that I didn’t know existed,” Mesko said.
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