Consequences of Needle-Related Medical Procedures: A Hermeneutic Study With Young Children (3-7 Years)

Accessing the Lived Experiences of Children with Illness in Sweden for Health Care Research

BACKGROUND

Children are a relatively marginalized group when doing research in the context of illness, young children particularly so. This even though children can and should contribute their point of view in providing evidence-based care. This article contributes the experiences of Nurse Researchers in gathering research data in Sweden on the lived experiences of children undergoing needle-related medical procedures, living with home mechanical ventilation or undergoing treatment for cancer.

METHODS

Nine published articles from four unique Swedish PhD dissertations in Caring Science formed the basis for the present paper where various open and critical qualitative approaches for gathering data were used.

RESULTS

Accessing and interpreting the lived experiences of ill children in healthcare research presents methodological, ethical, and cultural challenges. As with health care contexts in other countries, capturing the ill child's experiences in Sweden requires several different methods. Health researchers in Sweden must navigate a complex landscape of communication barriers, emotional and psychological challenges, and structural issues within the healthcare system to effectively access and understand the lived experiences of children.

CONCLUSIONS

This paper adds to the knowledge base of research with a focus on gathering the experiences of children with illness within a Swedish health care context. These insights underscore the importance for all researchers of using child-friendly, inclusive methods to understand children's lived experiences thus ensuring their voices are heard and respected in health research. Children's and families' inability to speak the native language of a country cannot be a hinder for inclusion, but rather be encouraged.

The effect of virtual reality glasses used during intravenous catheter application on the Child's emotional responses

PURPOSE

This study was conducted to determine the effect of virtual reality glasses used during intravenous catheter insertion on the child's emotional responses.

DESIGN AND METHODS

The sample of the research, which was carried out as a randomized controlled experimental study, consisted of 102 children, including 51 in the control group and 51 in the study group, who were aged between 7 and 12 years and were on treatment in the pediatric emergency department(PED). Research data were collected using a Descriptive Data Form for Children and the Children's Emotional Manifestation Scale. No intervention was applied to the control group. After the tourniquet was tied in the study group, the children started watching a video of their choice through virtual reality glasses. When the process was completed, the video was stopped. During this period, the child was evaluated using the Children's Emotional Manifestation Scale.

RESULTS

A statistically significant difference was found between the Children's Emotional Manifestation Scale scores of the children in the study and control groups (p = 0.000). The scores of the children in the study group were statistically significantly lower than the scores of the children in the control group.

CONCLUSION

During the intravenous catheter insertion process, children who watched cartoons on virtual reality glasses showed less negative emotional behavior than those who did not.

PRACTICE IMPLICATIONS

The use of virtual reality glasses is a developing technology in child health services, and it is recommended to encourage their use in these services.

Lifeworld hermeneutics: An approach and a method for research on existential issues in caring science

BACKGROUND AND AIM

The aim of the present article was to elaborate on a research approach and method called 'lifeworld hermeneutics'. Significant to lifeworld hermeneutics is that interpretation is the main methodological instrument for explaining and understanding existential research questions and lived experiences. From a caring science perspective, this often refers to research that aims to gain a deeper understanding of existential phenomena and issues, such as existential meaning of health, well-being, homelessness, lostness, suffering and ageing, as well as what it means to experience unhealthiness and illness, the need for care, and caring that responds to such needs.

DESIGN

Theoretical paper.

RESULT

The article briefly covers ontology and epistemology that clarifies the meaning and importance of a lifeworld hermeneutic attitude. This is followed by suggestions for how to perform a lifeworld hermeneutic study, expressed in relation to methodological principles for the interpretation, validation and structuring of interpretations. Thereafter, follow reflections on how to use theoretical or philosophical support to develop and deepen existential interpretations. The findings of lifeworld hermeneutic research consist of existential interpretations where the researcher, with an open and pliable attitude towards the phenomenon and the aim of the study, clarifies, explains and suggests new ways of understanding participants' lived experiences; the researcher should maintain such an attitude towards their understanding of the phenomenon as well.

CONCLUSION

The lifeworld hermeneutical approach and method described in this article makes it possible to further deepen the understanding and knowledge about existential issues that is relevant for caring and caring science.

The effect of two different methods on reducing the pain and fear during phlebotomy to children: A randomized controlled trial

INTRODUCTION

Reducing pain and fear during painful medical procedures in children is important since mismanagement of pain causes the child and parent to feel anxious, which can have negative long-term consequences. This study aimed to evaluate the effects of two different distraction methods in reducing pain and fear during the phlebotomy procedure in children.

METHOD

The study, which has a randomized controlled experimental design was conducted between July and October 2020 with 111 children aged 6-12 years who underwent phlebotomy in the emergency department of a public hospital and their parents. The children were randomly assigned to soap bubble blowing (n:37), ball squeezing (n:37) and control (n:37) groups. During the phlebotomy, soap bubble blowing, and ball squeezing methods were used as active distraction methods. Data were collected using the Wong Baker Faces Pain Rating Scale, and the Children's Fear Scale.

RESULTS

The pain scores of the soap bubble blowing group and the ball squeezing group during the phlebotomy procedure were found to be lower than the control group (p < 0.001). In addition, the soap bubble blowing group had lower fear scores than the ball squeezing and control groups (p < 0.001).

CONCLUSION

The active distraction methods used in the study reduced pain and fear during the phlebotomy procedure. In addition, the method of soap bubble blowing was found to be a more effective method in reducing fear. Distraction methods should be used as a nursing intervention to reduce pain and fear during the phlebotomy procedure in children.

Topical anesthetics for needle-related pain in adults and children (TOPIC): a mini-review

Purpose

Healthcare professionals (HCP) perform various needle procedures that can be distressing and painful for children and adults. Even though many strategies have been proven effective in reducing distress and pain, topical anesthetic use before needle procedures is uncommon. However, there are limited studies in the existing literature comparing specifically liposomal lidocaine and tetracaine hydrochloride topical creams.

Source

This systematic review analyzed studies on the use of two anesthetic creams, Liposomal Lidocaine (Maxilene®) and Tetracaine hydrochloride (Ametop™), in children and adults undergoing a needle-related procedure. Databases searched: PubMed, CINAHL, ClinicalTrials. Only randomized controlled trials (RCT) and Controlled Clinical Trials (CCT) studies were included. Cochrane Collaboration's Risk of Bias assessment tool was used. Strictly minimally invasive procedures were included to standardize different skin needle interventions.

Principal findings

Only one study with 60 participants was available to be included in this review. No statistically significant difference was found in the mean pain score among both interventions. The outcomes of self-reported distress during cannulation and on HCP satisfaction were not reported. However, physiological characteristics associated with stress/anxiety and on cannulation success rate were reported and did not show statistical significance.

Conclusion

Little to no evidence regarding the most efficient cream between liposomal lidocaine and tetracaine hydrochloride for pain management during needle-related procedures was found. Further studies, particularly RCT with larger sample sizes and standardized outcome measures, are needed to confirm the relative efficacy of either anesthetic cream.

The effect of visual and/or auditory distraction techniques on children's pain, anxiety and medical fear in invasive procedures: A randomized controlled trial

PURPOSE

This study was conducted to determine the effects of visual and/or auditory distraction techniques applied to children aged 7-12 during invasive procedures on pain, anxiety, and medical fear.

METHODS

This single-blinded, randomized controlled trial was carried out in the pediatric emergency department of a public hospital between November 2021 and March 2022. In the study, 144 children were assigned to three different intervention groups, in which a kaleidoscope, music, and virtual reality were applied during invasive procedures, and the control group in which the standard invasive procedure was applied, by using the stratified block randomization method. The data were collected using a Personal Information Form, Wong-Baker Faces Pain Rating Scale, Children's Anxiety Meter-State, and Child Medical Fear Scale.

RESULTS

In the study, the levels of pain, anxiety, and medical fear after the invasive procedure were lower in the intervention groups than in the control group. In addition, there was no difference between the three different distraction techniques in terms of reducing pain and medical fear, but the virtual reality application was more effective in reducing the level of anxiety.

CONCLUSION

Visual and/or auditory distraction techniques are effective methods that can be used by nurses in pediatric healthcare to reduce invasive procedure-related pain, anxiety, and medical fear.

IMPLICATIONS FOR PRACTICE

This study provides evidence that can guide the use of non-pharmacological methods such as distraction to prevent the traumatic effects of invasive procedures in children.

Young children's perspectives on treatment and care: A qualitative study using narrative and play-based interviewing

PURPOSE

To explore young children's (age 3-6 years) own experiences and perceptions of treatment and care when living with a chronic illness.

DESIGN AND METHODS

The study employed a qualitative research design using a narrative and play-based interview approach. Individual face-to-face, narrative and play-based interviews were conducted with eight young children age 3-6 years with type 1 diabetes or cystic fibrosis. The play sessions took place at the home of the children and were video recorded. Interpretative phenomenological analysis was used to analyse the data and frame the study.

RESULTS

Our analysis identified six main themes: 1. Children understood illness through their bodily experience of treatment and care, 2. Children's experience of care and treatment ranged from a feeling of powerlessness to a sense of agency, 3. Children depended on their parents to provide comfort, advocacy and protection, 4. Children's perceptions of treatment and care were inherently related to their experiences of familiarity, interpersonal relationships and trust, 5. Children with type 1 diabetes did not perceive that they played an active role during consultations, and 6. Children associated medical treatment with receiving tangible rewards or positive feedback.

CONCLUSION

Children expressed a need to feel safe and build agency. They experienced this through participation and interpersonal relationships with healthcare professionals.

PRACTICE IMPLICATIONS

We should prioritize the establishment and implementation of age-appropriate psychosocial care practices that support young children in participating, forming relationships, and building trust.

Positive effects of a child-centered intervention on children's fear and pain during needle procedures

To examine whether children experience less fear or pain using a child-centered intervention and if there were differences between the intervention group and the control group regarding heart rate, time required for the procedure, success rate for the cannula insertion, and patient satisfaction. A controlled single-center case study of observational design, with one control and one intervention group. Child self-reported fear or pain levels did not reveal any differences for those receiving the intervention compared with controls. However, according to a behavioral observation measure with the Procedure Behavior Check List, effects of the intervention were lower distress in relation to fear and pain during the cannula insertion. The time it took to perform the cannula insertion also decreased significantly in the intervention group. More children in the intervention group reported that they were satisfied with the needle procedure compared with the children in the control group. The child-centered intervention provides reduced observed distress related to fear and pain in children undergoing a cannula insertion and reduced total time by more than 50%. This study found that child involvement in care strengthen their ability to manage a needle procedure.

Effects of an Immersive Virtual Reality Intervention on Pain and Anxiety Among Pediatric Patients Undergoing Venipuncture: A Randomized Clinical Trial

IMPORTANCE

Venipuncture is one of the most painful and distressing procedures experienced by pediatric patients. Emerging evidence suggests that providing procedural information and distraction using immersive virtual reality (IVR) may reduce pain and anxiety among children undergoing needle-related procedures.

OBJECTIVES

To examine the effects of IVR on reducing the pain, anxiety, and stress experienced by pediatric patients undergoing venipuncture.

DESIGN, SETTING, AND PARTICIPANTS

This 2-group randomized clinical trial recruited pediatric patients aged 4 to 12 years undergoing venipuncture from a public hospital in Hong Kong between January 2019 and January 2020. Data were analyzed from March to May 2022.

INTERVENTIONS

Participants were randomly allocated to an intervention (an age-appropriate IVR intervention offering distraction and procedural information) or a control (standard care only) group.

MAIN OUTCOMES AND MEASURES

The primary outcome was child-reported pain. Secondary outcomes included child-reported anxiety, heart rate, salivary cortisol, length of procedure, and satisfaction of health care professionals with the procedure (rated on a 40 point scale, with higher scores indicating greater satisfaction). Outcomes were assessed 10 minutes before, during, immediately after, and 30 minutes after the procedure.

RESULTS

A total of 149 pediatric patients were recruited, with 86 female patients (57.7%) and 66 patients (44.3%) diagnosed with fever. Compared with the 74 participants in the control group (mean [SD] age, 7.21 [2.49] years), the 75 participants in the IVR group (mean [SD] age, 7.21 [2.43] years) reported significantly less pain (β = -0.78; 95% CI, -1.21 to -0.35; P < .001) and anxiety (β = -0.41; 95% CI, -0.76 to -0.05; P = .03) immediately after the intervention. Health care professional satisfaction in the IVR group (mean [SD] score, 34.5 [4.5]) was significantly higher than that in the control group (mean [SD] score, 32.9 [4.0]; P = .03). Moreover, the length of venipuncture procedure in the IVR group (mean [SD] duration, 4.43 [3.47] minutes) was significantly shorter than that in the control group (mean [SD] duration, 6.56 [7.39] minutes; P = .03).

CONCLUSIONS AND RELEVANCE

In this randomized clinical trial, integrating procedural information and distraction in an IVR intervention for pediatric patients undergoing venipuncture significantly improved pain and anxiety in the IVR group compared with the control group. The results shed light on the global trends of research on IVR and its clinical development as an intervention for other painful and stressful medical procedures.

TRIAL REGISTRATION

Chinese Clinical Trial Registry identifier: ChiCTR1800018817.

To embrace and be present: The lived experiences of nurse-led consultations in Sweden from the perspective of pediatric nurses

PURPOSE

This study describes the lived experiences of nurse-led consultations in pediatric emergency departments from the perspective of pediatric nurses.

DESIGN AND METHODS

A descriptive qualitative study with a reflective lifeworld research approach was used to explore nurses' experiences of nurse-led consultations. The study was conducted through meaning-oriented individual interviews with ten pediatric nurses.

RESULTS

The results are grouped into four themes: (a) embracing the encounter and being touched by it; (b) having time to be present and committed; (c) having the ability and trusting in one's intuition; and (d) negotiating between families' wishes and the organization's guidelines.

CONCLUSIONS

Our study shows that nurse-led consultations conducted in separate nurse-led reception areas promote a positive experience of the consultations from the perspective of pediatric nurses. In a nurse-led consultation, a nurse's confidence in their ability to provide care is connected to time, broad skills and knowledge, and a supportive organization.

PRACTICE IMPLICATIONS

As the rising global population increases the demand for healthcare services, pediatric emergency departments must streamline their services to provide patient-safe, high-quality health care. Nurse-led consultations are an effective means of meeting these growing demands. This study contributes to an understanding of pediatric nurses' experiences at both the individual level and a more structured level, namely that families' wishes and an organization's guidelines do not always coincide.

The Children's Action-Reaction Assessment Tool (CARAT) as an observational technique for assessing symptom management: An initial validation study with children aged 3-7 years undergoing needle procedures

PURPOSE

For many children, needle procedures are fearful events that are often painful. The first step in symptom management is to assess the child's pain and fear, and the next step is to use coping strategies to provide symptom relief for children who experience or feel pain and fear during procedures. The Children's Action-Reaction Assessment Tool (CARAT) is built on action-reaction strategies. This study aimed to determine the inter-rater reliability of the CARAT when used during needle procedures with 3- to 7-year-old children. DESIGN AND METHODS: We used a quantitative approach in which 21 children were observed by two independent observers during needle procedures to evaluate the inter-rater reliability of the CARAT. Data were analysed with descriptive statistics, and the observation scores were calculated with an intraclass correlation coefficient (ICC) test on SPSS for Windows, version 25.

RESULTS

The completed CARAT indicated the use of action-reaction strategies. Neither action nor reaction strategies were frequently used. The parents were seldom involved in the procedure. The inter-rater reliability showed a sufficient correlation between the observers. PRACTICE IMPLICATIONS: This study showed promising results for the inter-rater reliability of the CARAT, which can be used to facilitate care for children. The observational tool can be used to assess the use of action-reaction strategies in conjunction with needle procedures in children aged 3-7 years.

Health care provider's responses to children's resistance to peripheral vein cannulation: A qualitative observational study

AIMS AND OBJECTIVES

Health care and treatment should be voluntary, but restraint is often used during treatment of children. Knowledge about how health care providers respond to preschool children's resistance is lacking and can help understand current paediatric care in hospitals. The aim of the present article was to provide knowledge about how healthcare providers respond to preschool children's resistance during the clinical procedure of peripheral vein cannulation.

DESIGN

An explorative qualitative research design was developed for this study.

METHODS

Observations with video recording were used to collect data. Eight nurses and seven physicians participated in the study (n = 15). Their responses to preschool children's (n = 6) resistance were studied during 14 attempts of peripheral vein cannulation. Consolidated criteria for reporting qualitative research (COREQ) were used.

RESULTS

The healthcare providers made 380 responses to children's resistive expressions, interpreted within four main types, responses to acknowledge the child, responses to distract the child, responses to persuade the child and responses to reject the child. All main types of responses were used by both nurses and physicians. Regardless of the amount of resistance the children expressed, all children received distracting and acknowledging responses. Rejecting responses were used approximately twice as much in the implementation phase as in the preparation phase. Distraction, persuasion and rejection began in the preparation phase and increased in the implementation phase.

CONCLUSIONS

The main types and sub-types of responses showed how healthcare providers use a wide array of responses to meet children's resistance during peripheral vein cannulation.

RELEVANCE TO CLINICAL PRACTICE

The results can enable health care providers to become aware of their own practices during peripheral vein cannulation and other clinical procedures and to elaborate on their use of responses that can be considered intrinsically less child-friendly.

'I Would Rather Be Having My Leg Cut off Than a Little Needle': A Supplementary Qualitative Analysis of Dentally Anxious Children's Experiences of Needle Fear

Fear of needles is common in childhood, with up to 50% being affected to some degree. In individuals who are dentally anxious, the prevalence may be as high as 91%. Fear of needles, and therefore intra-oral injections can have negative impacts on children's quality of life and healthcare experiences, including a requirement for pharmacological methods to facilitate dental treatment. The aim of this study is to identify whether dentally anxious children report fear of injections and explore how these children experience a fear of needles in a dental setting. A supplementary analysis of interviews collected as part of two previous studies relating to children with dental anxiety. Five main themes were identified: feelings about needles; the nature of needle fear; the context of the fear, its consequences and how children tried to control the process. Children showed a desire to have control of their healthcare interventions, and wanted to trust the healthcare professionals giving the injections. There is evidence that children with dental anxiety also experience fear of needles, including intra-oral injections. Further primary qualitative research is needed to explore this topic in more depth and to design appropriate child centred interventions to reduce needle fear.

Children's individual voices are required for adequate management of fear and pain during hospital care and treatment

BACKGROUND

Children often report both fear and pain in conjunction with clinical care and treatment. Interventions developed in the field have still not been sufficient to prevent and relieve children's fear and pain. More knowledge, from children's own perspectives, is needed about how they deal with their experiences.

AIM

To explore child-identified strategies that children use to manage fear and pain during needle-related medical procedures in hospital.

METHODS

Interviews with children, age 4-12 years, with experience of hospital care were analysed qualitatively using content analysis.

RESULTS

Children have self-identified strategies for dealing with fear and pain during hospital care and treatment. The strategies vary depending on examination or treatment and on how the child felt at that particular day. Children describe what they can do themselves, how adults can empower them and support from surroundings as strategies that give them a choice and a voice. Children wished to have influence, decide when and how information should be given, scream out loud or squeeze something hard, to deal with fear and pain. The results also show that children tried to be brave, gain control and think positively. Something nice to look at and opportunities to play with others also contributed.

CONCLUSIONS

Strategies vary between children and are used differently on different occasions. Healthcare professionals pose a threat to the child's needs and ability to use their strategies due to lack of knowledge of the child's chosen strategies.

Children's fear of needle injections: a qualitative study of training sessions for children with rheumatic diseases before home administration

BACKGROUND

Treatment of rheumatic diseases in children often includes long-term needle injections, which represent a risk for refusing medication based on potential needle-fear. How nurses manage children's fear and pain during the initial educational training session of subcutaneous injections, may affect the management of the subsequent injections in the home settings. The aim of this study was to explore how children expressed fear and pain during these training sessions, and how adults' communication affected children's expressed emotions.

METHODS

This qualitative explorative study used video observations and short interviews during training sessions in a rheumatic hospital ward. Participants were children between five and fifteen years (n = 8), their parents (n = 11) and nurses (n = 7) in nine training sessions in total. The analysis followed descriptions of thematic analysis and interaction analysis.

RESULTS

The children expressed fears indirectly as cues and nonverbal signs more often than direct statements. Three children stated explicit being afraid or wanting to stop. The children worried about needle-pain, but experienced the stinging pain after the injection more bothersome. The technical instructions were detailed and comprehensive and each nurse shaped the structure of the sessions. Both nurses and parents frequently offered coping strategies unclearly without sufficient time for children to understand. We identified three main adult communication approaches (acknowledging, ambiguous and disregarding) that influenced children's expressed emotions during the training session.

CONCLUSIONS

Children's expression of fear was likely to be indirectly, and pain was mostly related to the injection rather than the needle stick. When adults used an acknowledging communication and offered sufficient coping strategies, children seemed to become involved in the procedure and acted with confidence. The initial educational training session may have a great impact on long-term repeated injections in a home setting by providing children with confidence at the onset.

Medical procedures in children using a conceptual framework that keeps a focus on human dimensions of care - a discussion paper

Purpose: Children’s perspectives in the context of health service delivery have historically been seen as unimportant. They have been viewed as unintelligent, unable to effectively share or tell of their experiences or fully participate in their care, potentially resulting in a sense of dehumanisation.

Method: The present paper illustrates children’s experiences when undergoing medical procedures, using application of the eight dimensions of humanised care theoretical framework.

Results: Findings from six published papers were reflectively interrogated to identify implicit findings related to the dimensions of humanised care. These implicit findings show ways of caring for childrenwhichcan lead to enhanced human sensitivity in care or conversely where the dimensions of being human are obscured to greater or lesser degrees and can result in forms of dehumanisation.

Conclusions: Inadvertent dehumanising features of practice can be mediated by encouraging the inclusion of children’s own lifeworld perspective and make room for their voices in both care and research. In this way the present well documented power imbalance could be addressed. Adding the value of the theoretical framework highlights areas of need for young children to be cared for as human beings.

Experiences of Young Children With Cancer and Their Parents With Nurses' Caring Practices During the Cancer Trajectory

Children with cancer require repeated hospitalizations and the family's everyday life and routines undergo change. Concrete descriptions of how nurses act when caring for children with cancer throughout the various phases of care and treatment are sparsely highlighted in the literature. The aim of this study was to describe young children with cancer and their parents' experiences of nurses' caring practices over a 3-year period, from diagnosis to follow-up. This study is based on semistructured interviews with 25 children newly diagnosed with cancer, aged 1 to 6 years, and their parents, connected to a pediatric oncology unit in Sweden. Child and parent data were analyzed with a deductive content analysis using Swanson's theory of caring. The result shows that nurse care practices directed toward young children with cancer and their parents are to some extent similar across a 3-year period from diagnosis to follow-up but also differ in some ways. Nurses' caring practices aim to support children and parents in the transition to a "new normal." Child- and family-friendly care processes include the following: creating hope and a trustful relationship, asking rather than assuming, providing knowledge and information, performing tasks skillfully, displaying an interest in the child's and parents' life outside the hospital, and helping the family to trust in the future and other health care providers. Based on these results, we recommend the development of a standardized and structured nursing care plan or clinical guideline with detailed information on how to carry out clinical nurse care practices in the different phases.

Effects of immersive virtual reality intervention on pain and anxiety among pediatric patients undergoing venipuncture: a study protocol for a randomized controlled trial

Background

Venipuncture is one of the most painful and distressing procedure experienced by pediatric patients. Evidence suggests that distraction combined with age-appropriate procedural information can effectively decrease procedural pain and anxiety in pediatric patients. Immersive virtual reality (IVR) can simultaneously provide complete distraction and procedural information to patients.

Methods

Guided by the gate control theory and Lazarus and Folkman’s theory, this study aims to examine the effects of IVR intervention on reducing the pain, anxiety and stress, the duration of venipuncture, and the satisfaction of healthcare providers for the procedure. A randomized controlled trial with repeated assessments will be conducted. A total of 200 pediatric patients aged 4–12 years will be recruited from a regional public hospital and randomly assigned to either the intervention or control group. The study will use two age-appropriate IVR modules that consist of procedural information. The intervention group will receive IVR intervention, whereas the control group will receive standard care only. The cost-effectiveness of IVR intervention will be compared with that of standard care. Outcome evaluation will be conducted at four time points: 10 min before, during, immediately after, and 30 min after the procedure. Intention to treat and generalized estimating equation model will be used to analyze the data.

Discussion

This study is the first of its kind to adopt IVR intervention with age-appropriate procedural information for pediatric patients undergoing venipuncture. Findings of the proposed study may: (1) provide a novel, facile, and cost-effective intervention that can be used virtually at any time and place to manage pain and anxiety; and (2) shed light on the global trends of research and clinical development of IVR as an intervention for other painful and stressful medical procedures.

Trial registration

Chinese Clinical Trial Registry, ChiCTR1800018817. Registered on 11 October 2018.

Electronic supplementary material

The online version of this article (10.1186/s13063-019-3443-z) contains supplementary material, which is available to authorized users.

Heparin or Sodium Chloride for Prolonging Peripheral Intravenous Catheter Use in Children - A Systematic Review

PROBLEM

Children's wellbeing should always be considered but during hospital stay, many children experience pain due to medical procedures such as inserting a peripheral venous catheter. In order to prolong the time in situ and to avoid the necessity to change the catheter frequently, it can be flushed with either heparin or sodium chloride. Since heparin has negative side effects, the aim of this study was to examine whether or not there is any scientific support for intermittent flush with heparin being more efficient in extending the time in situ as compared to intermittent flush with sodium chloride.

ELIGIBILITY CRITERIA

A systematic review structured according to PICO was performed. The databases used were PubMed, CINAHL and Cochrane Library, and eligible study designs were systematic reviews and randomized controlled double-blinded trials. The studies were critically appraised and synthesized, after which an evidence grading was performed.

SAMPLE

Two systematic reviews and four randomized controlled double-blinded trials were included.

RESULTS

The systematic reviews were assessed as high quality and the randomized controlled double-blinded trials assessed as moderate quality. The results showed both significant differences, and no significant differences between heparin groups and sodium chloride groups regarding time in situ.

CONCLUSIONS

Our conclusion is that heparin might not be necessary but no guidelines are possible to develop.

IMPLICATIONS

Since heparin has negative side effects among children and no significant result in favor of heparin was found, more studies are needed in order to provide evidence-based care.

Expressive Behaviors Demonstrating "Well Done" in Young Children Undergoing Blood Sampling or Vaccination as Perceived by Parents and Nurses in Japan

The present study aimed to clarify expressive behaviors demonstrating "well done" in young children aged 3-7 years who were undergoing blood sampling or vaccination, as these behaviors were perceived by parents and nurses in Japan. This study applied a qualitative descriptive design using a retrospective recall approach. Data obtained from semi-structured interviews conducted with 14 parents and 15 nurses were divided into meaning units, each containing a complete expressive behavior demonstrating "well done." These meaning units were then coded and categorized. A total of 103 secondary codes were extracted and grouped into 36 subcategories and the following six categories: emotional expression, exploratory behavior, moving on from blood sampling or vaccination, self-regulating behavior, expression of intentions to adults, and response to questioning by adults. The most common emotions displayed before needle removal in the category emotional expression were those related to "displeasure," while those displayed after needle removal were related to "pleasure." The present findings suggest that parents and nurses perceived the change from displeasure- to pleasure-related emotions after needle removal in young children as "well done." Observation of the expressive behaviors identified in the present study will enable the clinical evaluation of "well done" in young children undergoing blood sampling or vaccination, thereby aiding nurses in providing positive feedback to young children and their parents.

Effectiveness of vibratory stimulation on needle-related procedural pain in children: a systematic review protocol

REVIEW QUESTION/OBJECTIVE

The objective of this systematic review is to identify, evaluate and synthesize evidence on the effectiveness of vibratory stimulation to reduce needle-related procedural pain in children aged 18 years and under.The review will address the following question: Is vibratory stimulation effective in reducing needle-related procedural pain in children aged 18 years and under, in comparison with no stimulation for needle-related procedures?

Young children with severe congenital malformations (VACTERL) expressed mixed feelings about their condition and worries about needles and anaesthesia

AIM

Our knowledge of the perceptions that children with severe congenital malformations have of their health, treatment and how to improve hospital care is limited. This study focused on patients with vertebral defects, anal atresia, cardiac defects, tracheo-oesophageal fistula, renal anomalies and limb abnormalities (VACTERL).

METHODS

We interviewed 10 children aged five to eight years with VACTERL association who were treated in a Swedish tertiary paediatric surgical centre, using a computer-assisted technique called In My Shoes. The interviews were analysed by qualitative content analysis.

RESULTS

The children described their awareness of their health history and said they felt proud but different due to their physical dysfunction. They were happy to visit the hospital to meet familiar staff, but expressed negative feelings about missing normal life. They were afraid of needle-related procedures and not wakening up after anaesthesia. Various ways of coping with difficult situations were expressed, and suggestions to improve hospital care were voiced.

CONCLUSION

Careful follow-up of these children by multidisciplinary teams is crucial to optimise their health and functional status. Fear of medical procedures may be reduced by carefully delivered information, listening to the children, providing continuity of care and creating individual care strategies.

Distraction-Based Interventions for Children Undergoing Venipuncture Procedures: A Randomized Controlled Study

Little is known about the effects of distraction techniques when undertaking medical procedures with hospitalized pediatric patients in Asian countries. This study examined the effects of distraction interventions on behavioral distress related to venipuncture procedures in Taiwanese children aged 3 to 7 years. Using concealed randomization, eligible children were allocated to receive a picture book ( n = 92), or animated cartoon ( n = 92) compared with routine oral instructions ( n = 92), when being injected with an intravenous cannula. Two trained observers independently scored the responses of each child using the Observational Scale of Behavioral Distress-Revised before, during, and after the procedure. All children experienced distress during needle insertion, but distress was less in the distraction-based intervention groups. Moreover, distraction interventions were more effective for children aged 4 to 5 years. Our culturally tailored intervention engaged child participants, was age-appropriate, and could be adapted for use in other Chinese cultures.

Experiencing Support During Needle-Related Medical Procedures: A Hermeneutic Study With Young Children (3-7Years)

Needle-related medical procedures (NRMPs) are something that all young children need to undergo at some point. These procedures may involve feelings of fear, pain and anxiety, which can cause problems later in life either when seeking healthcare in general or when seeking care specifically involving needles. More knowledge is needed about supporting children during these procedures.

AIM

This study aims to explain and understand the meaning of the research phenomenon: support during NRMPs. The lived experiences of the phenomenon are interpreted from the perspective of younger children.

METHOD

The analysis uses a lifeworld hermeneutic approach based on participant observations and interviews with children between 3 and 7years of age who have experienced NRMPs.

RESULTS

The research phenomenon, support for younger children during NRMPs, is understood through the following themes: being the centre of attention, getting help with distractions, being pampered, becoming involved, entrusting oneself to the safety of adults and being rewarded. A comprehensive understanding is presented wherein younger children experience support from adults during NRMPs in order to establish resources and/or strengthen existing resources.

CONCLUSIONS

The manner in which the child will be guided through the procedure is developed based on the child's reactions. This approach demonstrates that children are actively participating during NRMPs. Supporting younger children during NRMPs consists of guiding them through a shared situation that is mutually beneficial to the child, the parent and the nurse. Play during NRMP is an important tool that enables the support to be perceived as positive.