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Signorelli C, Kelada L, Wakefield CE, Alchin JE, Adam I, Hoffmann P. Pilot testing "Teach Ted": A digital application for children undergoing blood tests and their parents. PEC INNOVATION 2024; 4:100251. [PMID: 38274175 PMCID: PMC10808896 DOI: 10.1016/j.pecinn.2023.100251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 01/27/2024]
Abstract
Objective In this pilot study, we evaluated the acceptability and preliminary evidence of the impact of a new educational mobile application, "Teach Ted", for children undergoing blood tests. Methods Parents of children (4-10 years) completed questionnaires on anxiety and pain before their child had a blood test, and after using Teach Ted and receiving their blood test. Health professionals at each patient's blood test (e.g. technician/nurse) completed questionnaires on patient outcomes and procedure-related outcomes (e.g. time taken). Results Nine parents and eight health professionals participated. All but one parent (n = 8/9) reported Teach Ted was useful. Seventy-eight percent (n = 7/9) reported they would use Teach Ted again. All health professionals who completed the acceptability measure (n = 3/3) strongly agreed that Teach Ted was relevant/helpful. Many parents perceived Teach Ted helped reduce their/child's anxiety (n = 3/5, 60% and n = 4/6, 67% respectively), although child's pain and child's/parent's anxiety remained similar before and after using Teach Ted (all p > 0.05). The average blood test duration was 7.6 min (range ≤1 to 22), which health professionals (n = 3/3) reported was not elongated by offering Teach Ted. Conclusions Participants reported that Teach Ted was acceptable. Further evaluation of Teach Ted's impact on patient's outcomes are needed. Innovation Teach Ted is an innovative mobile application with potential to educate young children about their upcoming procedure and mitigate negative outcomes.
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Affiliation(s)
- Christina Signorelli
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
- School of Clinical Medicine, UNSW Medicine & Health, Discipline of Paediatrics, UNSW Sydney, NSW, Australia
| | - Lauren Kelada
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
- School of Clinical Medicine, UNSW Medicine & Health, Discipline of Paediatrics, UNSW Sydney, NSW, Australia
| | - Claire E. Wakefield
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
- School of Clinical Medicine, UNSW Medicine & Health, Discipline of Paediatrics, UNSW Sydney, NSW, Australia
| | - Joseph E. Alchin
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
- School of Clinical Medicine, UNSW Medicine & Health, Discipline of Paediatrics, UNSW Sydney, NSW, Australia
| | - Irene Adam
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Peta Hoffmann
- Acute Allied Health Services, Canberra Hospital, ACT, Australia
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Yilmaz G, Demir Acar M. The effect of animal-assisted intervention on fear in children in the emergency department: A randomized controlled trial. J Pediatr Nurs 2024:S0882-5963(24)00358-0. [PMID: 39358068 DOI: 10.1016/j.pedn.2024.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 08/24/2024] [Accepted: 09/23/2024] [Indexed: 10/04/2024]
Abstract
AIM This study aimed to determine the effect of animal-assisted intervention on the fears of hospitalized children in the emergency department (ED). MATERIALS AND METHODS The randomized controlled trial was conducted between April and June 2023 in the Central Black Sea Region of Turkiye. The study included 70 children aged 5 to 7 years old (the study group was 35, and the control group was 35). The study and control groups were randomly assigned to strata using simple randomization. While goldfish were used for animal-assisted intervention in the study group, routine care was continued in the control group. The "Child Fear Scale" and "The Scale of Children's Fear of Nursing Interventions and Instruments Used in Hospital" were used as data collection tools. RESULTS The mean score of the fear scale in the post-test scores of the study group children was significantly lower than the control group (p < 0.001). After the animal-assisted intervention, the mean fear scores of the children in the care study group toward nursing interventions and the materials used decreased significantly (p < 0.001). Furthermore, when the two groups were compared, the difference between the post-test scores was not significant (p > 0.05). CONCLUSION Animal-assisted intervention was determined to be effective in decreasing the fear levels of the children in the study group. PRACTICE IMPLICATIONS During hospitalization in the emergency department, methods appropriate to the child's developmental level and animal-assisted interventions were found to be effective in reducing children's fear levels.
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Affiliation(s)
- Gulmelek Yilmaz
- Tokat Gaziosmapasa University, Institute of Graduate Studies, Tokat, Turkiye.
| | - Mukaddes Demir Acar
- Tokat Gaziosmapasa University, Faculty of Health Sciences, Department of Pediatric Nursing, Tokat, Turkiye.
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Palmér L, Nyström M, Karlsson K. Lifeworld hermeneutics: An approach and a method for research on existential issues in caring science. Scand J Caring Sci 2024; 38:200-209. [PMID: 37655653 DOI: 10.1111/scs.13201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/09/2023] [Accepted: 07/29/2023] [Indexed: 09/02/2023]
Abstract
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.
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Affiliation(s)
- Lina Palmér
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Maria Nyström
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Katarina Karlsson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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DeCosta P, Skinner TC, Sørensen JL, Topperzer MK, Grabowski D. Young children's perspectives on treatment and care: A qualitative study using narrative and play-based interviewing. J Pediatr Nurs 2023; 73:211-220. [PMID: 37862851 DOI: 10.1016/j.pedn.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/09/2023] [Accepted: 10/09/2023] [Indexed: 10/22/2023]
Abstract
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.
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Affiliation(s)
- Patricia DeCosta
- Department of Prevention, Health Promotion & Community Care, Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark; Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
| | - Timothy C Skinner
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark; Australian Centre for Behavioural Research in Diabetes, Melbourne, Australia
| | - Jette Led Sørensen
- Juliane Marie Centre & Mary Elizabeths Hospital - Rigshospitalet for Children, Teens and Expecting Families, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Martha Krogh Topperzer
- Juliane Marie Centre & Mary Elizabeths Hospital - Rigshospitalet for Children, Teens and Expecting Families, Copenhagen, Denmark
| | - Dan Grabowski
- Department of Prevention, Health Promotion & Community Care, Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
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Kristensen HN, Laugesen B, Stinson J, Haslund-Thomsen H. The Impact and Influence of Hospital Clowns on Hospitalized Children Undergoing Painful Procedures: A Mixed Methods Study. Glob Qual Nurs Res 2023; 10:23333936231186599. [PMID: 37538194 PMCID: PMC10395183 DOI: 10.1177/23333936231186599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 08/05/2023] Open
Abstract
Hospital clowns are widely used in pediatric settings. However, the field of pain and pain experience in children is complex and multifaceted. Therefore, the aim of this study was to expand knowledge on the impact and influence of hospital clowns on 4 to 15-year-old children's experiences of managing painful procedures and conditions. A convergent mixed method study was conducted integrating findings from three individual studies: a prospective non-blinded study and two focused ethnographic studies. The findings illuminated a child-clown interaction characterized by a close relationship evolving during a continuous, mutually focused attention, conceptualized as WE. This WE represent a responsive interaction between child and clown, which supported the child during the procedures, and generated three integrated findings: an age-differentiated approach; understanding the child's condition; and previous experiences as a part of the child's history. The WE approach strengthened the child's competences and ability to manage during painful procedures.
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Affiliation(s)
| | - Britt Laugesen
- Aalborg University Hospital, Denmark
- Aalborg University, Denmark
| | - Jennifer Stinson
- University of Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
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Kleye I, Sundler AJ, Darcy L, Karlsson K, Hedén L. Children's communication of emotional cues and concerns during a preoperative needle procedure. PATIENT EDUCATION AND COUNSELING 2022; 105:1518-1523. [PMID: 34625321 DOI: 10.1016/j.pec.2021.09.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 09/13/2021] [Accepted: 09/27/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This study explores children's expressions of emotional cues and concerns during needle procedures, nurses' responses and findings in relation to children's age and sex. METHODS Twenty-six children aged 6-12 years were video recorded during a preoperative needle procedure. Emotional communication was analyzed using Verona Coding Definitions of Emotional Sequences. RESULTS A total of 111 cues or concerns were identified in the observed needle procedures, with a distribution of 77 cues and 34 concerns. A majority of children (85%) expressed emotional cues through non-verbal communication. No differences between child age or sex related to expressed emotion were found. The child elicited the communicated emotion in 98% of sequences. Nurses' responses were coded as not providing space for communication in 75% of sequences. CONCLUSION Children are capable of expressing their emotional distress, primarily non-verbally, during needle procedures. A child showing less overt expressions during a needle procedure does not necessarily experience less fear or pain. The nurses' communication focused on practical information during the needle procedure, with less attention to the child's distress. PRACTICE IMPLICATIONS Nurses need to develop strategies to be aware of emotions the child communicates before, during and after a needle procedure.
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Affiliation(s)
- Ida Kleye
- Department of Health Sciences Faculty of Caring Science, Work Life and Social Welfare, University of Borås, S-501 90 Borås, Sweden.
| | - Annelie J Sundler
- Department of Health Sciences Faculty of Caring Science, Work Life and Social Welfare, University of Borås, S-501 90 Borås, Sweden
| | - Laura Darcy
- Department of Health Sciences Faculty of Caring Science, Work Life and Social Welfare, University of Borås, S-501 90 Borås, Sweden
| | - Katarina Karlsson
- Department of Health Sciences Faculty of Caring Science, Work Life and Social Welfare, University of Borås, S-501 90 Borås, Sweden
| | - Lena Hedén
- Department of Health Sciences Faculty of Caring Science, Work Life and Social Welfare, University of Borås, S-501 90 Borås, Sweden
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Karlsson K, Johnson E, Nilsson S. 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. J SPEC PEDIATR NURS 2021; 26:e12334. [PMID: 33821544 DOI: 10.1111/jspn.12334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Katarina Karlsson
- Faculty of Caring Sciences, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Ensa Johnson
- Centre for Augmentative and Alternative Communication, University of Pretoria, Hatfield, Pretoria, South Africa
| | - Stefan Nilsson
- Institute of Health and Care Sciences and the University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Dewi MM, Nurhaeni N, Hayati H. The effect of storytelling on fear in school-age children during hospitalization. LA PEDIATRIA MEDICA E CHIRURGICA 2021; 43. [PMID: 37184322 DOI: 10.4081/pmc.2021.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Indexed: 11/23/2022] Open
Abstract
Hospitalization places children in conditions that may nurture fears of new surroundings, strangers, and unknown actions. Storytelling can be administered as a distraction from the fears that a child experiences during treatment. This study aims to determine the effectiveness of storytelling against fear due to hospitalization in school-age children admitted to the hospital. This study used a quantitative approach with a pre-experimental design and the method used was nonequivalent control group pretest-posttest design. Subjects in this study consisted of two groups namely the intervention and the control groups. The total number of respondents was n=32 and located at the Maternity and Children Hospital in Indonesia. Bivariate analysis showed that storytelling intervention had a significant relationship with the fear of hospitalization among the hospitalized school-age children (p-value=0.001< 0.05). Also, there was a significant difference between the fear score in the intervention and the control groups (p-value=0.001<). Therefore, applying storytelling in the nursing intervention of pediatric patients in hospitals can be recommended to minimize the fear in children.
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Kleye I, Hedén L, Karlsson K, Sundler AJ, Darcy L. Children's individual voices are required for adequate management of fear and pain during hospital care and treatment. Scand J Caring Sci 2020; 35:530-537. [PMID: 32363693 DOI: 10.1111/scs.12865] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 04/07/2020] [Indexed: 12/22/2022]
Abstract
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.
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Affiliation(s)
- Ida Kleye
- Department of Health Sciences, Faculty of Caring Science, Work life and Social Welfare, University of Borås, Borås, Sweden
| | - Lena Hedén
- Department of Health Sciences, Faculty of Caring Science, Work life and Social Welfare, University of Borås, Borås, Sweden
| | - Katarina Karlsson
- Department of Health Sciences, Faculty of Caring Science, Work life and Social Welfare, University of Borås, Borås, Sweden
| | - Annelie J Sundler
- Department of Health Sciences, Faculty of Caring Science, Work life and Social Welfare, University of Borås, Borås, Sweden
| | - Laura Darcy
- Department of Health Sciences, Faculty of Caring Science, Work life and Social Welfare, University of Borås, Borås, Sweden
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Sahlberg S, Karlsson K, Darcy L. Children's rights as law in Sweden-every health-care encounter needs to meet the child's needs. Health Expect 2020; 23:860-869. [PMID: 32319716 PMCID: PMC7495078 DOI: 10.1111/hex.13060] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/16/2020] [Accepted: 03/19/2020] [Indexed: 12/22/2022] Open
Abstract
Background In 2020, the United Nations Convention on the Rights of the Child (UNCRC) became law in Sweden. This puts extra demands on Swedish health care for children in need. This study aimed to investigate children's experiences and paediatric nurses' experiences of caring in accordance with the UNCRC. Methods Interviews were conducted in 2019 with 10 children and 13 nurses at a paediatric clinic in western Sweden. Child and nurse data were analysed separately with qualitative content analysis. The results are presented as a synthesis of the combined analysis of both data sets. Results Children did not always meet health‐care professionals with the necessary competence to care for them, and they were not always cared for in a child‐friendly environment. Even though nurses in paediatric care had the competence necessary to meet children's rights in health care, organizational issues made it challenging. Providing health care in accordance with the UNCRC principles required time and competence. Sufficient time to help children participate in their care and ensure that they feel secure was considered necessary—regardless of the health‐care context. Conclusion Health‐care encounters without the necessary time or competence can affect children and future encounters negatively. Instruments to safeguard children's rights in health care need to be developed and implemented, such as a documentation system to make children's rights visible and/or UNCRC certification. Implementation of UNCRC principles in all health‐care situations for children as standardized care requires competence, involvement, strong leadership and economic support. Children's voices in research can assist in guiding care.
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Affiliation(s)
- Sofia Sahlberg
- Department of Health Sciences, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Katarina Karlsson
- Department of Health Sciences, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Laura Darcy
- Department of Health Sciences, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Sørensen K, Skirbekk H, Kvarstein G, Wøien H. Children's fear of needle injections: a qualitative study of training sessions for children with rheumatic diseases before home administration. Pediatr Rheumatol Online J 2020; 18:13. [PMID: 32033566 PMCID: PMC7007654 DOI: 10.1186/s12969-020-0406-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 01/09/2020] [Indexed: 01/10/2023] Open
Abstract
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.
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Affiliation(s)
- Kari Sørensen
- Department of Nursing Science, University of Oslo, Oslo, Norway
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
- Department of Undergraduate Studies, Lovisenberg Diaconal University College, Oslo, Norway
| | - Helge Skirbekk
- Department of Undergraduate Studies, Lovisenberg Diaconal University College, Oslo, Norway
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Gunnvald Kvarstein
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
- Department of Clinical Medicine, the Arctic University of Norway, Tromsø, Norway
| | - Hilde Wøien
- Department of Nursing Science, University of Oslo, Oslo, Norway
- Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
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12
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Vejzovic V, Bozic J, Panova G, Babajic M, Bramhagen AC. Children still experience pain during hospital stay: a cross-sectional study from four countries in Europe. BMC Pediatr 2020; 20:39. [PMID: 31996162 PMCID: PMC6988252 DOI: 10.1186/s12887-020-1937-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 01/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known whether children experience pain during hospital stay from the child's own perspective or not. The existing studies tend to be based on a small number of children and therefore have limitations concerning the generalisability of the results. AIM The aim of this study was to describe children's self-reported pain and experience concerning pain management during hospital stay. METHODS This study has a quantitative cross-sectional design with descriptive statistics as data analysis. RESULTS A total of 786 questionnaires, Pain in Children in Hospital, were distributed in four countries with the response rate of 75% which was almost equal between countries. Our result showed that 87% (503/579) children at hospital self-reported pain during the past 24 h. Nearly 63% of the children reported a pain score of > 5 the last 24 h. Most of children reported that they had received a question about pain from the hospital staff, and that the staff observed and assessed their pain. Totally 95% reported that they were satisfied with their pain relief during the last 24 h. CONCLUSION Our study showed that when children were given the possibility to self-report pain, nearly 2/3 expressed that they had experienced pain during hospital stay. However, most of them reported satisfaction with pain management and their pain relief.
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Affiliation(s)
- V. Vejzovic
- Faculty of Health and Society, Department of Care Science, Malmö University, SE-205 06 Malmö, Sweden
| | - J. Bozic
- School of nursing, Vinogradska, Zagreb, Croatia
| | - G. Panova
- University Goce Delcev, Stip, Macedonia
| | - M. Babajic
- Clinic for Anaesthesiology and Rheumatology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - A-C Bramhagen
- Faculty of Health and Society, Department of Care Science, Malmö University, SE-205 06 Malmö, Sweden
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Karlsson K, Galvin K, Darcy L. Medical procedures in children using a conceptual framework that keeps a focus on human dimensions of care - a discussion paper. Int J Qual Stud Health Well-being 2019; 14:1675354. [PMID: 31621530 PMCID: PMC6807864 DOI: 10.1080/17482631.2019.1675354] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
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.
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Affiliation(s)
- Katarina Karlsson
- Faculty of Caring Science, Work Life and Social Welfare, University of Boras , Boras , Sweden
| | - Kathleen Galvin
- Faculty of Caring Science, Work Life and Social Welfare, University of Boras , Boras , Sweden.,School of Health Science, University of Brighton , Brighton , UK
| | - Laura Darcy
- Faculty of Caring Science, Work Life and Social Welfare, University of Boras , Boras , Sweden
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Abstract
INTRODUCTION Hospitalized children often describe needle-related procedures as the worst pain possible and such procedures may be emotionally traumatic. The use of hospital clowns (HCs) related to painful medical procedures in children may offer pain relief, but this has not been systematically evaluated. The objective of this study was to assess the effect of a therapeutic clown in comparison with standard care on the experience of pain in children receiving venipuncture. MATERIALS AND METHODS A sample of 116 children aged 4 to 15 years consecutively admitted to the hospital was allocated to either the experimental (presence of HC) or control group (standard care) before venipuncture. Self-reported pain after the procedure was assessed using the Faces Pain Scale combined with a 0 to 10 Numerical Rating Scale. Separate analysis was conducted in age groups from 4 to 6 (N=37) and 7 to 15 (N=74) years. RESULTS Without the clown present, the mean pain score (2.7±2.8) was not significantly different between the 2 age groups. Children aged 7 to 15 years had lower pain scores when the clown was present compared with the control group (P=0.025). Children aged 4 to 6 years had higher pain scores with the clown present, although the difference was not statistically significant (P=0.054). Children with pain (N=49) or previous experiences with venipuncture (N=56) did not score pain significantly differently. DISCUSSION Assessing the pain experience of children receiving venipuncture with the presence of an HC indicates a pain relieving effect for children older than 6 years. However, future studies should carefully study the effects on younger children where mixed effects may be present.
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15
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Enskär K, Darcy L, Björk M, Knutsson S, Huus K. Experiences of Young Children With Cancer and Their Parents With Nurses' Caring Practices During the Cancer Trajectory. J Pediatr Oncol Nurs 2019; 37:21-34. [PMID: 31526068 DOI: 10.1177/1043454219874007] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
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.
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Affiliation(s)
- Karin Enskär
- CHILD Research Group, Jönköping University, Sweden
| | | | - Maria Björk
- CHILD Research Group, Jönköping University, Sweden
| | | | - Karina Huus
- CHILD Research Group, Jönköping University, Sweden
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16
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Nilsson S, Holstensson J, Johansson C, Thunberg G. Children's Perceptions of Pictures Intended to Measure Anxiety During Hospitalization. J Pediatr Nurs 2019; 44:63-73. [PMID: 30683283 DOI: 10.1016/j.pedn.2018.10.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 10/17/2018] [Accepted: 10/21/2018] [Indexed: 12/19/2022]
Abstract
Many children experience anxiety during a hospital stay, which can have an adverse impact on their recovery and response to future hospital care. To facilitate assessment of anxiety in young children and children with communicative disabilities, the short S-STAI (short version of the State scale of the State-Trait Anxiety Inventory), has previously been adapted to a visual format. The aims of the present study were (a) to validate the pictures used to represent emotions and the steps of a quantitative scale ('a lot' - 'some' - 'a little'), including to determine whether any of them should be replaced, and (b) to assess different pictures to be used for a qualitative scale ('good/like' - 'in between/so-so' -'bad/dislike') in the same instrument. A total of 103 children aged 5-8 years were asked to choose verbal labels for pictures of facial expressions intended to represent emotions, match those pictures with the emotional categories used in the short S-STAI (Tense/Nervous, Worried/Afraid, Calm/Relaxed, and Happy/Content) and indicate their preferences for pictures intended to represent the steps of a quantitative scale and a qualitative one. The children understood both scales and the differences between positive and negative emotions in the short S-STAI. The older children (aged 7 and 8) significantly more often chose a picture for each step of the scales that was intended to represent that particular step. The article discusses implications for the choice of pictures representing emotional states in the short S-STAI and presents recommended pictures.
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Affiliation(s)
- Stefan Nilsson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | | | | | - Gunilla Thunberg
- DART center for AAC and AT, Sahlgrenska University Hospital, Gothenburg, Sweden
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17
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Teksoz E, Düzgüner V, Bilgin I, Ocakci AF. The Impact of a Nursing Coping Kit and a Nursing Coping Bouncy Castle on the Medical Fear Levels of Uzbek Refugee Children. J Pediatr Nurs 2018; 39:68-73. [PMID: 29395790 DOI: 10.1016/j.pedn.2018.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 01/09/2018] [Accepted: 01/10/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Emel Teksoz
- Health School of Mustafa Kemal University, Hatay, Turkey.
| | - Vesile Düzgüner
- School of Health Sciences of Ardahan University, Ardahan, Turkey.
| | - Ibrahim Bilgin
- Education Faculty of Mustafa Kemal University, Hatay, Turkey.
| | - Ayse Ferda Ocakci
- School of Nursing, Koc University, Istanbul, Turkey; Güzelbahçe sok. Nişantaşı, İstanbul, Turkey.
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18
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Yuwen W, Lewis FM, Walker AJ, Ward TM. Struggling in the Dark to Help My Child: Parents' Experience in Caring for a Young Child with Juvenile Idiopathic Arthritis. J Pediatr Nurs 2017; 37:e23-e29. [PMID: 28778610 PMCID: PMC5681389 DOI: 10.1016/j.pedn.2017.07.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 06/28/2017] [Accepted: 07/18/2017] [Indexed: 01/04/2023]
Abstract
PURPOSE The purpose of this study is to describe parents' experiences in caring for 2-5-year-old children with juvenile idiopathic arthritis (JIA). DESIGN AND METHODS A qualitative study using single-occasion in-depth interviews was conducted. Nine parents (eight mothers and one father) were interviewed in-person or via telephone. Data were analyzed using inductive content analysis. Methods used to protect the trustworthiness of study results included maintenance of an audit trail, peer debriefing, and member checks. RESULTS The core construct Struggling in the Dark to Help My Child explained parents' experience in six domains: not knowing, trying to reach out in the dark, feeling my child's pain, working out the kinks to stay on top to manage, feeling drained by the whole process, and being hard on the entire household. Parents struggled with the unknown, searched for resources, witnessed their child's suffering without knowing how to help, and tried every possible way to stay on top of the child's illness and treatment, even when they felt drained physically and emotionally. JIA not only consumed their lives, but also affected the entire family, including the siblings and spouse, and the relationships among family members. CONCLUSION AND IMPLICATIONS Findings highlight the day-to-day lived challenges parents face when caring for a young child with JIA. Healthcare providers including nurses need to assess the particular needs of an ill child and parents as well as the impact of the illness on the physical and psychosocial health of the entire family so that proper resources can be provided.
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Affiliation(s)
- Weichao Yuwen
- Nursing and Healthcare Leadership, University of Washington Tacoma, Tacoma, WA, United States.
| | - Frances M Lewis
- Family and Child Nursing, University of Washington, Seattle, WA, United States
| | - Amy J Walker
- Family and Child Nursing, University of Washington, Seattle, WA, United States
| | - Teresa M Ward
- Family and Child Nursing, University of Washington, Seattle, WA, United States
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19
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Wang Y, Liu Q, Yu JN, Wang HX, Gao LL, Dai YL, Jin X, Zuo F, Liu J, Bai CF, Mu GX, Chai XM, Zhang YJ, Li YX, Yu JQ. Perceptions of parents and paediatricians on pain induced by bone marrow aspiration and lumbar puncture among children with acute leukaemia: a qualitative study in China. BMJ Open 2017; 7:e015727. [PMID: 28939570 PMCID: PMC5623544 DOI: 10.1136/bmjopen-2016-015727] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To obtain in-depth insight into the perceptions of parents and paediatricians in China regarding current procedural pain management on bone marrow aspirations and lumbar punctures in paediatric haemato-oncology department. DESIGN, SETTING AND PARTICIPANTS This qualitative study was conducted in a 4500-bed university hospital in northwest China. To collect data, in-depth semistructured interviews were conducted with parents of children with acute leukaemia (n=12) and haemato-oncology paediatricians (n=11) using purposive sampling. Interviews were audiotaped and transcribed and subjected to thematic analysis. RESULTS The suffering of procedural pain among paediatric patients was not adequately recognised and properly treated at the paediatric haemato-oncology department. The current paediatric procedural pain management is inadequate for paediatric patients. Crucial factors were identified including lack of awareness about the damage of uncontrolled pain in children, parents' low supportive ability, the limited capacity to provide general analgesia by anaesthetists, inadequate knowledge in the usage of analgesia and sedation and lack of efficient analgesic for children's procedural pain. The participants strongly expected optimal interventions to improve paediatric procedural pain management. CONCLUSIONS The result suggested a perceived and actual poor management of paediatric procedural pain in haemato-oncology department in northwest China. A relevant pain management education programme for paediatricians and parents as well as an effective pain medication are urgently needed in northwest China. TRIAL REGISTRATION Chinese Clinical Trial Registry. Identifier: ChiCTR-INR-16007989.
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Affiliation(s)
- Yu Wang
- Nursing School, Ningxia Medical University, Yinchuan, China
| | - Qiang Liu
- Nursing School, Ningxia Medical University, Yinchuan, China
| | - Jia-Ning Yu
- Department of Paediatric Hematology-Oncology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Hai-Xia Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lu-Lu Gao
- Nursing School, Ningxia Medical University, Yinchuan, China
| | - Ya-Liang Dai
- Nursing School, Ningxia Medical University, Yinchuan, China
| | - Xin Jin
- Neurological Surgery Department, Ningxia People’s Hospital, Yinchuan, China
| | - Feng Zuo
- Department of Paediatric Hematology-Oncology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Juan Liu
- Nursing School, Ningxia Medical University, Yinchuan, China
| | - Cai-Feng Bai
- Nursing School, Ningxia Medical University, Yinchuan, China
| | - Guo-Xia Mu
- Nursing School, Ningxia Medical University, Yinchuan, China
| | - Xiao-Min Chai
- Nursing School, Ningxia Medical University, Yinchuan, China
| | - Yin-Juan Zhang
- Nursing School, Ningxia Medical University, Yinchuan, China
| | - Yu-Xiang Li
- Nursing School, Ningxia Medical University, Yinchuan, China
| | - Jian-Qiang Yu
- Department of Pharmacology, College of Pharmacy, Ningxia Medical University, Yinchuan, China
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20
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Christian BJ. Translational Research - Adapting to the Stress and Challenges of Chronic Conditions in Children and Adolescents. J Pediatr Nurs 2016; 31:736-739. [PMID: 27742101 DOI: 10.1016/j.pedn.2016.09.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 09/26/2016] [Indexed: 01/09/2023]
Affiliation(s)
- Becky J Christian
- School of Nursing, University of Louisville, Louisville, KY, United States.
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