Children's experiences of pain in an accident and emergency department

Controlling pain in sick or injured children continues to be a challenge, particularly for those working in Accident and Emergency departments. Empathising with the subjectivity of a child's experience, provides insight into the range of significant events that frequently exacerbate the quality and intensity of physical pain; the latter being compounded by the 'emotion' pain of fear, misunderstanding, separation or distress. This article stresses the importance of an holistic approach for effective pain management. The developmental aspects of the perceptual, interpretative and expressive components of pain will be explored and a range of pain assessment tools considered.

Child-focused perioperative education: helping children understand and cope with surgery

It is essential for all health care providers to remember that children experience hospitalization and perioperative experiences differently than adults because of their development stage and personal life experiences. Advocating for preparatory and concurrent perioperative education and support continues to be supported in the literature. Therapeutically based play and support can be adapted throughout the perioperative setting, from start to finish. It can also promote understanding, compliance, and satisfaction for both the child and family, and can provide the health care worker with a more satisfying patient-focused plan of care.

Operation Fascination

Operation Fascination is an educational program about the perioperative experience targeted at the school-age community. The goals are to help children gain a better understanding of the perioperative process by incorporating it in the school curriculum and extracommunity curricula and to make the perioperative nurse more aware of school-age children's misconceptions. A literature search showed that little has been written about perioperative education of school-age children outside the health care institution. Therefore, this article shares the development and initiation of Operation Fascination as well as describes the importance and benefits of offering this type of program to the community.

Psychosocial factors affecting a child's capacity to cope with surgery and recovery

Medical stressors associated with illness and surgery make extraordinary psychological demands on children. A child's coping abilities, both emotional and cognitive, are at the heart of adjustment to these demands. Social support is also an important element in the child's ability to recover psychologically. Finally, a child's previous medical experiences, psychiatric problems, and learning disabilities may affect the child's behavior.

Making A&E less traumatic for children. Paediatric nurses in accident and emergency

1. A visit to A&E is often a child's first introduction to hospital. 2. A specially designed unit and specifically trained staff are required. 3. Nurses should act as the child's and family's advocate. 4. All nurses in A&E should be aware of child development.

Reduction of anxiety in pediatric patients: effects of a psychopedagogical intervention programme

A psychopedagogical intervention programme is used as a resource to improve children's life in hospital and to prevent the negative effects of hospitalization. One of those negative effects is the children's anxiety. The statistical analysis showed the effectiveness of this programme in order to reduce and prevent the emergence of anxiety symptoms. Therefore, its generalization and use are recommended.

Preparing children for day surgery

This study measured the effect of a group preoperative teaching program on the level of children's emotional distress during day surgery. The sample consisted of 30 children, ages 3 through 10, scheduled for elective surgery. One group attended a structured program and received procedural and sensory information within 2 weeks of their surgery. The other group did not receive this intervention. A t test identified significant differences between the groups. Children who attended the preoperative teaching program demonstrated less emotional distress than children who did not receive this intervention. These findings reinforce the positive outcomes of preoperative teaching programs that provide procedural and sensory information to children as preparation for day surgery.

Partners in growth: implementing family-centered changes in the neonatal intensive care unit

Although there are several forces driving changes with regard to parents within neonatal intensive care units (NICUs), they all culminate in the ideals represented in family-centered care. This article examined the variables that are perceived by parents to be barriers to their assumption of parental roles while their infants were hospitalized in the NICU. Data were used to support and implement pragmatic changes in program development and service delivery within the NICU.

Information-seeking coping and anxiety in school-age children anticipating surgery

This study examined the relation between coping behavior and anxiety among school-age children anticipating an elective tonsillectomy and/or adenoidectomy. The demographic variables of age, gender, previous hospitalization, and birth order were also studied in relation to both coping and anxiety. Interview methods were utilized to measure information-seeking and information-limiting coping behaviors and feelings of anxiety. The results of this study indicate that children who used primarily information-seeking or information-limiting strategies were successful (as measured by low anxiety levels) in managing the stress of anticipated hospitalization. Children using information-seeking strategies for some, but not all, aspects of the hospitalization experience reported the greatest anxiety. The demographic variables were not related to either anxiety or coping.

Survival from a wild animal attack: a case study analysis of adolescent coping

TOPIC

Adolescent coping strategies and long-term effects of a life-threatening event are examined in this retrospective case study.

PURPOSE

To describe the hospital care and follow-up support given to an 11-year-old girl who was savagely mauled by a cougar. An in-depth analysis of the patient's significant memories six-and-a-half years after the incident is also presented.

SOURCES

Two hour semi-structured, information gathering interviews with the adolescent when she was 16 years old.

RESULTS

The outcome of this case study analysis served as a partial debriefing of the experience for the adolescent girl.

IMPLICATIONS FOR NURSING PRACTICE

This case study provides a useful resource to practitioners and patients who may experience similar situations. Nurses have a role to play in anticipating and preparing children for later hospital-based, post-trauma interventions and assisting other adolescents who are injured and hospitalized.

Information Needs of the Siblings of Critically Ill Children

This study explored parental and sibling perceptions and feelings about sibling information needs during a pediatric admission to an intensive care unit (ICU). Using a qualitative research design, parents (n = 14) and school-age siblings (n = 12) of children who were patients in ICU were interviewed using open-ended questions. Themes of information that the parents report having given to the siblings were similar to the themes that siblings report having heard. However, parents reported that the siblings had numerous questions about the reasons for hospitalization and expectations for the future of the family. The findings indicate that parents may neither be aware of the effects of the ICU experience on the siblings nor have the knowledge and skill to assist them. Parents may need counseling to increase their awareness of the siblings' need for information and teaching to increase skill in providing the information.

Parent and professional perceptions about stress and coping strategies during a child's lengthy hospitalization

The two goals of this study were (1) to describe the stressors and coping strategies of families whose children with chronic illness require lengthy hospitalizations and (2) to compare family reports of stress and coping strategies to professionals perceptions of the same. A non-randomized sample of 13 families (13 mothers and 5 fathers) whose child with chronic illness was hospitalized for a minimum of 30 days and 11 professionals who worked with such children were interviewed in a semi-structured survey using open-ended questions. Key phrases from family interviews were organized into categories of family-reported stressors and coping strategies. Key phrases from professional interviews were categorized into family stressors and descriptions of challenging families. Families and professionals reported that personal emotions and communication problems were the most predominant stressors.

Effective transitions for families: life beyond the hospital

The numbers of innovative inhospital programs for children are growing. Family-focused activities can help families cope better with the hospital experience. Yet, to promote optimal healing, health care providers must recognize that a family's life goes on after the hospital stay. Many stresses make life difficult for families. Most families are resilient, but many can benefit from help in managing the transition from hospital to home. Valuing the small things children do, connecting with other families, locating community resources, understanding the short and long term needs of the child are some of the critical transitions for families.

[The child in the hospital]

Children and adolescents live in a rich emotional world of imagination and fantasies. In the hospital they are confronted with a highly complex field of transactions. This generates images and feelings within the child and the adolescent which can be either healing, illness-provoking or maintaining certain problems. If doctors, nurses and other staff-members encourage the child and his relatives to develop favorable images, this may support the process of healing and enhance the quality of life, in dying patients as well. The presentation shows some of the images children have developed in the hospital and reports constructive and destructive transactional patterns related to the hospitalized patient.

Psychological preparation for pediatric oncology patients undergoing painful procedures: a methodological critique of the research

Hypnosis and cognitive-behavioral packages are effective in preparing pediatric oncology patients for bone marrow aspiration and lumbar puncture. However, the relative efficacy of different preparations has not been determined, and potent components of preparation packages have yet to be identified. Further, factors hypothesized to moderate effectiveness of preparation (e.g., cognitive development) have not been investigated. Finally, due to a failure to employ process measures, the extent to which hypothesized mediators of behavior change (e.g., self-efficacy) are modified by preparation is unclear. Following an overview of empirical investigations, we make recommendations for addressing these limitations in future research.

How parents cope with the experience of neonatal intensive care

Thirty-two mothers and 25 fathers described their coping efforts during the initial weeks of their preterm infants' hospitalization in a neonatal intensive care unit. Utilizing procedures developed by Lazarus and Folkman (1984) in which coping is linked with a specific stressful event, parents reported what they did to cope with the stressor they perceived to be the most stressful. They also completed the Ways of Coping Questionnaire (Folkman & Lazarus, 1988). Results showed that there were similarities and differences in the types of coping strategies used by mothers and fathers. In addition, factors such as neonatal morbidity and appraisal of control were differentially associated with the use of certain types of coping strategies. Implications for future research and clinical practice are discussed.

Post-hospitalisation behavioural changes in children: effects of day-stay surgery

Two comparable groups of young children, aged one to ten years, underwent minor ear, nose and throat surgery. One group was treated as day-stay patients at a private clinic and the other group spent two nights in a teaching hospital. Anaesthesia and surgery were similar in both groups. The incidence of post-hospitalisation behavioural changes was reported as 56.6% for the day-stay cases and 62.5% for the in-patients. The relative frequencies of the reported changes were not different between the groups except for apathy in the in-patient group and sleeping in parents bed in the day-stay group (p < 0.001). Parental satisfaction with the experience was high, 77% of the comments being positive.

Preparation for surgery and adjustment to hospitalization

One of every four children will be hospitalized at least once before reaching school age. The physical and psychosocial stress of hospitalization may be influenced by the child's developmental level, causing behavioral changes, somatic complaints, and a prolonged hospital stay. Through the use of careful development assessments, preoperative tours, and therapeutic play techniques fears can be allayed, misconceptions corrected, emotionally charged issues addressed, and a positive self-image created.

Parenting and child distress during cancer procedures: a multidimensional assessment

We examined the relationship between children's distress during invasive cancer procedures and parent anxiety, parent disciplinary attitudes, and parent behavior during the medical procedure. Sixty-six children with cancer and their parents were evaluated during a routine bone marrow aspiration. Significantly higher levels of distress were obtained for young (under age 8) versus older children. Patterns of relationships with parent variables also varied by age. Anxious parents of young children reported relying on less effective discipline strategies. They also were less reassuring prior to to medical procedure. Age differences in the correlations between child distress and parenting are discussed in terms of developmental differences in children's dependence on caregivers for emotional regulation and control. Implications for clinical distress reduction programs are also discussed.