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Näsström M, Junehag L, Häggström M, Holmström-Rising M. A reflexive thematic analysis of ambulance nurses' experience of facilitating child-centered care. Int Emerg Nurs 2023; 70:101324. [PMID: 37597278 DOI: 10.1016/j.ienj.2023.101324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/21/2023] [Accepted: 07/07/2023] [Indexed: 08/21/2023]
Abstract
INTRODUCTION Ambulance nurses' (ANs) feel less confident treating children. According to the United Nations Convention on Child Rights, there is a provision to safeguard children's rights. Child-Centered Care (CCC) strives to lift children's voices in healthcare. AIM To describe ambulance nurses' experiences of facilitating child-friendly care. METHOD A qualitative approach with Reflexive Thematic Analysis was performed on seventeen individual semi-structured interviews. RESULT One overarching theme, caring with the child in center, and three themes were developed: adapting to follow the child's lead, being reliable by balancing the trust, stepping back and supporting. DISCUSSION The ANs' communication with the children was honest and straightforward. Letting the child and the parents perform the care together reduced the child's anxiety. Guided participation was used by ANs, expanding the child's initiative. CONCLUSION The ANs work according to CCC, but unknowingly. It is important and beneficial to elevate the CCC to a conscious level. The ANs could refer to CCC in training new colleagues, reflecting on cases, and incorporating the Child Act in their work.
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Affiliation(s)
- Mathias Näsström
- Mid Sweden University, Department of Health Sciences, Nursing, 83125 Östersund, Sweden.
| | - Lena Junehag
- Mid Sweden University, Department of Health Sciences, Nursing, 83125 Östersund, Sweden.
| | - Marie Häggström
- Mid Sweden University, Department of Health Sciences, Nursing, 85170 Sundsvall, Sweden.
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An emotional journey when encountering children in prehospital care: Experiences from ambulance nurses. Int Emerg Nurs 2023; 66:101239. [PMID: 36574740 DOI: 10.1016/j.ienj.2022.101239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 09/16/2022] [Accepted: 11/10/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Care encounters with children are a challenging and important task, but opportunities for such encounters are rarely available. Therefore, ambulance nurses (ANs) face difficulties in gaining experience in properly handling children, which can lead to stress for the ANs. A deeper understanding of ANs' emotions through the course of the care encounter is needed. AIM To describe how ambulance nurses' feel and manage their emotions before, during and after a care encounter with a child. METHODS A qualitative approach was adopted, with content analysis being performed on seventeen individual interviews. FINDINGS Three themes were identified: Feeling worried and insecure, Emotional surge, and Mixed feelings of satisfaction and concern. CONCLUSION The ANs experienced a range of emotions during a care encounter with children as they had little experience with it. More training and education in paediatric care could benefit ANs. The ANs use professionalism during care encounters to create a calm and secure atmosphere for families. Their will to bring about a safe journey for the child and family through the care encounter supersedes their nervousness. Reflection after a care encounter could strengthen their confidence in their professional role and reduce emotional distress in future encounters.
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Whitley GA, Hemingway P, Law GR, Siriwardena AN. Improving ambulance care for children suffering acute pain: a qualitative interview study. BMC Emerg Med 2022; 22:96. [PMID: 35659188 PMCID: PMC9164349 DOI: 10.1186/s12873-022-00648-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 05/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background Pain is a highly complex sensory and emotional experience. When a child suffers acute pain through illness or injury, they are often transported to hospital by ambulance. Pre-hospital pain management in children is poor, with 61% of children receiving suboptimal pain management. Consequences of poor pain management include the risk of developing post-traumatic stress disorder and altered pain perception. We aimed to identify clinicians’ perceptions of barriers, facilitators and potential improvements for the management of pre-hospital acute pain in children. Methods Qualitative face to face semi-structured recorded interviews were performed in one large UK ambulance service. Audio files were transcribed verbatim with thematic analysis used to generate themes. NVivo 12 was used to support data analysis. Findings were combined with existing evidence to generate a driver diagram. Results Twelve ambulance clinicians participated, including 9 registered paramedics and 3 emergency medical technicians. Median (IQR) age was 43.50 (41.50, 45.75) years, 58% were male, median (IQR) experience was 12 (4.25, 15.50) years and 58% were parents. Several themes relating to barriers and facilitators were identified, including physical, emotional, social, organisational, environmental, management, knowledge and experience. Improvement themes were identified relating to management, organisation and education. These data were combined to create a driver diagram; the three primary drivers were 1) explore methods to increase rates of analgesic administration, including utilising intranasal or inhaled routes; 2) reduce fear and anxiety in children, by using child friendly uniform, additional non-pharmacological techniques and more public interaction and 3) reduce fear and anxiety in clinicians, by enhancing training and optimising crew mix. Conclusions The quality of care that children receive for acute pain in the ambulance service may be improved by increasing rates of analgesic administration and reducing the fear and anxiety experienced by children and clinicians. Future research involving children and parents would be useful to determine the most important outcome measures and facilitate intervention development. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-022-00648-y.
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Teoh SE, Loh CYL, Chong RIH, Yaow CYL, Masuda Y, Han MX, Lin DJ, Lim YL, Ng JCH, Ng QX. A scoping review of qualitative studies on pre-hospital analgesia administration and practice. Am J Emerg Med 2022; 57:81-90. [DOI: 10.1016/j.ajem.2022.04.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/26/2022] [Indexed: 01/08/2023] Open
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Whitley GA, Hemingway P, Law GR, Jones AW, Curtis F, Siriwardena AN. The predictors, barriers and facilitators to effective management of acute pain in children by emergency medical services: A systematic mixed studies review. J Child Health Care 2021; 25:481-503. [PMID: 32845710 PMCID: PMC8422593 DOI: 10.1177/1367493520949427] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
We aimed to identify predictors, barriers and facilitators to effective pre-hospital pain management in children. A segregated systematic mixed studies review was performed. We searched from inception to 30-June-2020: MEDLINE, CINAHL Complete, PsycINFO, EMBASE, Web of Science Core Collection and Scopus. Empirical quantitative, qualitative and multi-method studies of children under 18 years, their relatives or emergency medical service staff were eligible. Two authors independently performed screening and selection, quality assessment, data extraction and quantitative synthesis. Three authors performed thematic synthesis. Grading of Recommendations Assessment, Development and Evaluation and Confidence in the Evidence from Reviews of Qualitative Research were used to determine the confidence in cumulative evidence. From 4030 articles screened, 78 were selected for full text review, with eight quantitative and five qualitative studies included. Substantial heterogeneity precluded meta-analysis. Predictors of effective pain management included: 'child sex (male)', 'child age (younger)', 'type of pain (traumatic)' and 'analgesic administration'. Barriers and facilitators included internal (fear, clinical experience, education and training) and external (relatives and colleagues) influences on the clinician along with child factors (child's experience of event, pain assessment and management). Confidence in the cumulative evidence was deemed low. Efforts to facilitate analgesic administration should take priority, perhaps utilising the intranasal route. Further research is recommended to explore the experience of the child. Registration: PROSPERO CRD42017058960.
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Affiliation(s)
- Gregory A Whitley
- Community and Health Research Unit, University of Lincoln, UK,Gregory A Whitley, Community and Health Research Unit, Sarah Swift Building, University of Lincoln, Brayford Wharf East, Lincoln LN5 7AT, Lincolnshire, UK.
| | - Pippa Hemingway
- Faculty of Medicine and Health Sciences, University of Nottingham, UK
| | - Graham R Law
- Community and Health Research Unit, University of Lincoln, UK
| | - Arwel W Jones
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Australia
| | - Ffion Curtis
- Lincoln Institute for Health, University of Lincoln, UK
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Handyside B, Pocock H, Deakin CD, Rodriguez-Bachiller I. An EXploration of the facilitators and barriers to paramedics' assessment and treatment of pain in PAediatric patients following Trauma (EX-PAT). Br Paramed J 2021; 6:10-18. [PMID: 34539250 PMCID: PMC8415212 DOI: 10.29045/14784726.2021.9.6.2.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background: Pain is a common symptom among patients presenting to ambulance services and is often associated with traumatic injury. Assessment and management of pain in children in the pre-hospital setting is suboptimal. This study aimed to understand the facilitators and barriers experienced by paramedics in their assessment and management of pain in children who have sustained traumatic injuries. Methods: Face-to-face, audio-recorded semi-structured interviews using a piloted topic guide were conducted with paramedics employed by South Central Ambulance Service NHS Foundation Trust. Interviews were professionally transcribed, coded manually and analysed using thematic analysis. Results: Eleven interviews were conducted; three themes related to assessment and three related to management were identified. Previous positive experiences of utilising pain scoring tools were identified as a facilitator to pain assessment, whereas a lack of confidence in using pain scoring tools was a barrier. Patients’ understanding of and compliance with the tools were both a facilitator and a barrier to assessment. Facilitators to management included personal sub-themes of colleagues/others, exposure, being a parent, technology, severity of the injury and subjective pain scoring. Organisational facilitators included medicines, routes, and alternative methods. Situational facilitators included patient-specific solutions and parents. Five personal barriers to management included medicines, skill, consequences to self or patient, negative interactions, and limited exposure. Three organisational barriers included medicines and routes, equipment issues and choices, and training and culture. Within the theme of situation, two sub-themes emerged: patient-specific issues and environment-specific issues. Novel facilitators to emerge were those of alternative methods and being a parent. Conclusion: A multitude of factors incorporating situational, organisational, and personal all combine to determine how paramedics treat paediatric trauma patients. A multi-stakeholder approach to providing clearer assessment tools, improved education, equipment, and pharmacy options may improve assessment and management compliance for the benefit of the patient.
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Affiliation(s)
- Barry Handyside
- South Central Ambulance Service NHS Foundation Trust ORCID iD: https://orcid.org/0000-0002-1842-6582
| | - Helen Pocock
- South Central Ambulance Service NHS Foundation Trust ORCID iD: https://orcid.org/0000-0001-7648-5313
| | - Charles D Deakin
- South Central Ambulance Service NHS Foundation Trust ORCID iD: https://orcid.org/0000-0002-2565-9771
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Whitley GA, Hemingway P, Law GR, Wilson C, Siriwardena AN. Predictors of effective management of acute pain in children within a UK ambulance service: A cross-sectional study. Am J Emerg Med 2019; 38:1424-1430. [PMID: 31864872 DOI: 10.1016/j.ajem.2019.11.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 10/25/2019] [Accepted: 11/28/2019] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE We aimed to identify predictors of effective management of acute pain in children in the pre-hospital setting. METHODS A retrospective cross-sectional study using electronic clinical records from one large UK ambulance service during 01-Oct-2017 to 30-Sep-2018 was performed using multivariable logistic regression. We included all children <18 years suffering acute pain. Children with a Glasgow Coma Scale score of <15, no documented pain or without a second pain score were excluded. The outcome measure was effective pain management (abolition or reduction of pain by ≥2 out of 10 using the numeric pain rating scale, Wong-Baker FACES® scale or FLACC [face, legs, activity, crying and consolability] scale). RESULTS 2312 patients were included for analysis. Median (IQR) age was 13 (9-16), 54% were male and the cause of pain was trauma in 66% of cases. Predictors of effective pain management include children who were younger (0-5 years) compared to older (12-17 years) (adjusted odds ratio [AOR] 1.53; 95% confidence interval [CI] 1.18-1.97), administered analgesia (AOR 2.26; CI 1.87-2.73), attended by a paramedic (AOR 1.46; CI 1.19-1.79) or living in an area of low deprivation (index of multiple deprivation [IMD] 8-10) compared to children in an area of high deprivation (IMD 1-3) (AOR 1.37; CI 1.04-1.80). Child sex, type of pain, transport time, non-pharmacological treatments and clinician experience were not significant. CONCLUSION These predictors highlight disparity in effective pre-hospital management of acute pain in children. Qualitative research is needed to help explain these findings.
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Affiliation(s)
- Gregory Adam Whitley
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, England, United Kingdom.
| | - Pippa Hemingway
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, England, United Kingdom
| | - Graham Richard Law
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, England, United Kingdom
| | - Caitlin Wilson
- North West Ambulance Service NHS Trust, Bolton, England, United Kingdom
| | - Aloysius Niroshan Siriwardena
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, England, United Kingdom
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Shoqirat N, Mahasneh D, Singh C, Al-Sagarat AY, Habashneh S. Barriers to nursing pain management in the emergency department: A qualitative study. Int J Nurs Pract 2019; 25:e12760. [PMID: 31297927 DOI: 10.1111/ijn.12760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/04/2019] [Accepted: 05/23/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although pain is a common complaint among patients presenting to emergency departments (EDs), there is a dearth of nursing literature about barriers to pain management. PURPOSE The study aimed to uncover and understand barriers to pain management in the ED from the registered nurse (RN) perspective. METHODS Semistructured interviews were conducted with 12 ED nurses in a Jordanian hospital. Data were collected throughout August 2016. RESULTS Two broad categories with subcategories emerged. The first category describes the idea of types of patient, which included three particular groups. These were patients who are violent, patients with relatives who are, and patients with expectations of care that nurses view as unrealistic. The second category describes the taxing ED environment, with two subcategories of staff shortages and physician dominance of pain management. Nurses reported feeling as if they are the victims of external factors and perceived that barriers affected teamwork and led to distress which impairs pain management. CONCLUSIONS The role of ED nurses in pain management is multifaceted. Therefore, implementing policies to overcome barriers such as violence among ED attenders and the perceived hostility of the ED environment through mandatory security systems, and continuing nursing education including for violence prevention may be beneficial.
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Affiliation(s)
| | | | - Charleen Singh
- Betty Irene Moore School of Nursing, UC Davis, Sacramento, California
| | - Ahmad Yahya Al-Sagarat
- Community and Mental Health Nursing Department, Faculty of Nursing, Mutah University, AL-Karak, Jordan
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