Health Care Providers' Experiences of the Non-Pharmacological Pain and Anxiety Management and Its Barriers in the Pediatric Intensive Care Units

From theory to practice: the inclusion of hospitalized children's families in painful procedures

OBJECTIVE

To understand nursing team professionals' strategies to include the family in painful procedures performed on hospitalized children.

METHOD

An exploratory-descriptive, qualitative study, carried out with nursing professionals. Data were collected through semi-structured interviews, guided by a script of topics, transcribed and submitted to thematic content analysis, in the light of Symbolic Interactionism, discussed considering the Family-Centered Care philosophy assumptions.

RESULTS

Two central categories emerged, "Theoretical perspective: the family as a care agent in painful procedures" and "Practical perspective: experiences, challenges and strategies in painful procedures for family inclusion", with their respective subcategories.

CONCLUSION

Nursing professionals have theoretical knowledge about family inclusion in painful procedures based on the assumptions: Family-Centered Care: dignity and respect; information sharing; joint participation; and family collaboration. However, knowledge is not applied in clinical practice; consequence of the interaction between beliefs and attitudes unfavorable to family presence.

COVID-19 pandemic in the intensive care unit: Psychological implications and interventions, a systematic review

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic produced changes in intensive care units (ICUs) in patient care and health organizations. The pandemic event increased patients’ risk of developing psychological symptoms during and after hospitalisation. These consequences also affected those family members who could not access the hospital. In addition, the initial lack of knowledge about the virus and its management, the climate of fear and uncertainty, the increased workload and the risk of becoming infected and being contagious, had a strong impact on healthcare staff and organizations. This highlighted the importance of interventions aimed at providing psychological support to ICUs, involving patients, their relatives, and the staff; this might involve the reorganisation of the daily routine and rearrangement of ICU staff duties.

AIM

To conduct a systematic review of psychological issues in ICUs during the COVID-19 pandemic involving patients, their relatives, and ICU staff.

METHODS

We investigated the PubMed and the ClinicalTrials.gov databases and found 65 eligible articles, upon which we commented.

RESULTS

Our results point to increased perceived stress and psychological distress in staff, patients and their relatives and increased worry for being infected with severe acute respiratory syndrome coronavirus-2 in patients and relatives. Furthermore, promising results were obtained for some psychological programmes aiming at improving psychological measures in all ICU categories.

CONCLUSION

As the pandemic limited direct inter-individual interactions, the role of interventions using digital tools and virtual reality is becoming increasingly important. All considered, our results indicate an essential role for psychologists in ICUs.

Moving toward Fear-Free Husbandry and Veterinary Care for Horses

Husbandry and veterinary procedures have the potential to generate fear and stress in animals. In horses, the associated responses can pose a significant safety risk to the human personnel involved in the procedure, as well as to the animal itself. Traditionally, physical restraint, punishment, and/or threat of an aversive, have been the most common strategies used to achieve compliance from the horse. However, from a welfare perspective, this is less than ideal. This approach also has the potential for creating a more dangerous response from the horse in future similar situations. When caring for companion animals, and captive animals within zoological facilities, there has been a steady transition away from this approach, and toward strategies aimed at reducing fear and stress during veterinary visits and when undertaking routine husbandry procedures. This review discusses the current approaches to horse care and training, the strategies being used in other animal sectors, and potential strategies for improving human safety, as well as the horse's experience, during husbandry and veterinary procedures.

Effects of cartoon watching and bubble-blowing during venipuncture on pain, fear, and anxiety in children aged 6-8 years: A randomized experimental study

PURPOSE

This study aimed to compare the effects of bubble-blowing (active distraction) and cartoon watching (passive distraction) techniques on pain, anxiety, and fear during venipuncture in children aged 6-8 years.

DESIGN AND METHODS

This experimental study randomly assigned 56 children aged 6-8 years to cartoon watching or bubble-blowing groups. The child, parent, and researcher assessed pain using the Wong-Baker FACES Pain Rating Scale, anxiety using the Children's State Anxiety Scale, and fear using the Children's Fear Scale. The study data were analyzed using the Chi-square tests and independent Sample t-tests.

RESULTS

The groups were similar in clinical and demographic characteristics. The scores on pain, anxiety, and fear during the procedure were lower in the cartoon watching group than in the bubble-blowing group (pain t(47) = 2.638, p = .013; anxiety t(47) = 2.358, p = .023; and fear t(47) = 2.784, p = .008).

CONCLUSION

This study revealed that cartoon watching as a passive distraction method was more effective in reducing pain, anxiety, and fear during venipuncture in children aged 6-8 years compared to bubble-blowing as an active distraction method.

PRACTICE IMPLICATIONS

The cartoon watching technique, which is affordable, easy to access, and effective (in reducing pain, anxiety, and fear), can be safely used during venipuncture in children aged 6-8 years.

COVID-19 pandemic: the impact on Canada’s intensive care units

The COVID-19 pandemic has exposed the precarious demand-capacity balance in Canadian hospitals, including critical care where there is an urgent need for trained health care professionals to dramatically increase ICU capacity.

The impact of the pandemic on ICUs varied significantly across the country with provinces that implemented public health measures later and relaxed them sooner being impacted more severely. Pediatric ICUs routinely admitted adult patients. Non-ICU areas were converted to ICUs and staff were redeployed from other essential service areas. Faced with a lack of critical care capacity, triage plans for ICU admission were developed and nearly implemented in some provinces.

Twenty eight percent of patients in Canadian ICUs who required mechanical ventilation died. Surviving patients have required prolonged ICU admission, hospitalization and extensive ongoing rehabilitation. Family members of patients were not permitted to visit, resulting in additional psychological stresses to patients, families, and healthcare teams. ICU professionals also experienced extreme psychological stresses from caring for such large numbers of critically ill patients, often in sub-standard conditions. This resulted in large numbers of health workers leaving their professions.

This pandemic is not yet over, and it is likely that new pandemics will follow. A review and recommendations for the future are provided.