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France E, Uny I, Turley R, Thomson K, Noyes J, Jordan A, Forbat L, Caes L, Silveira Bianchim M. A meta-ethnography of how children and young people with chronic non-cancer pain and their families experience and understand their condition, pain services, and treatments. Cochrane Database Syst Rev 2023; 10:CD014873. [PMID: 37795766 PMCID: PMC10552070 DOI: 10.1002/14651858.cd014873.pub2] [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] [Indexed: 10/06/2023]
Abstract
BACKGROUND Chronic non-cancer pain in childhood is widespread, affecting 20% to 35% of children and young people worldwide. For a sizeable number of children, chronic non-cancer pain has considerable negative impacts on their lives and quality of life, and leads to increased use of healthcare services and medication. In many countries, there are few services for managing children's chronic non-cancer pain, with many services being inadequate. Fourteen Cochrane Reviews assessing the effects of pharmacological, psychological, psychosocial, dietary or physical activity interventions for managing children's chronic non-cancer pain identified a lack of high-quality evidence to inform pain management. To design and deliver services and interventions that meet the needs of patients and their families, we need to understand how children with chronic non-cancer pain and their families experience pain, their views of services and treatments for chronic pain, and which outcomes are important to them. OBJECTIVES 1. To synthesise qualitative studies that examine the experiences and perceptions of children with chronic non-cancer pain and their families regarding chronic non-cancer pain, treatments and services to inform the design and delivery of health and social care services, interventions and future research. 2. To explore whether our review findings help to explain the results of Cochrane Reviews of intervention effects of treatments for children's chronic non-cancer pain. 3. To determine if programme theories and outcomes of interventions match children and their families' views of desired treatments and outcomes. 4. To use our findings to inform the selection and design of patient-reported outcome measures for use in chronic non-cancer pain studies and interventions and care provision to children and their families. The review questions are: 1. How do children with chronic non-cancer pain and their families conceptualise chronic pain? 2. How do children with chronic non-cancer pain and their families live with chronic pain? 3. What do children with chronic non-cancer pain and their families think of how health and social care services respond to and manage their child's chronic pain? 4. What do children with chronic non-cancer pain and their families conceptualise as 'good' chronic pain management and what do they want to achieve from chronic pain management interventions and services? SEARCH METHODS Review strategy: we comprehensively searched 12 bibliographic databases including MEDLINE, CINAHL, PsycInfo and grey literature sources, and conducted supplementary searches in 2020. We updated the database searches in September 2022. SELECTION CRITERIA To identify published and unpublished qualitative research with children aged 3 months to 18 years with chronic non-cancer pain and their families focusing on their perceptions, experiences and views of chronic pain, services and treatments. The final inclusion criteria were agreed with a patient and public involvement group of children and young people with chronic non-cancer pain and their families. DATA COLLECTION AND ANALYSIS We conducted a qualitative evidence synthesis using meta-ethnography, a seven-phase, systematic, interpretive, inductive methodology that takes into account the contexts and meanings of the original studies. We assessed the richness of eligible studies and purposively sampled rich studies ensuring they addressed the review questions. Cochrane Qualitative Methods Implementation Group guidance guided sampling. We assessed the methodological limitations of studies using the Critical Appraisal Skills Programme tool. We extracted data on study aims, focus, characteristics and conceptual findings from study reports using NVivo software. We compared these study data to determine how the studies related to one another and grouped studies by pain conditions for synthesis. We used meta-ethnography to synthesise each group of studies separately before synthesising them all together. Analysis and interpretation of studies involved children with chronic non-cancer pain and their families and has resulted in theory to inform service design and delivery. Sampling, organising studies for synthesis, and analysis and interpretation involved our patient and public involvement group who contributed throughout the conduct of the review. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each review finding. We used a matrix approach to integrate our findings with existing Cochrane Reviews on treatment effectiveness for children's chronic non-cancer pain. MAIN RESULTS We synthesised 43 studies sampled from 170 eligible studies reported in 182 publications. Included studies involved 633 participants. GRADE-CERQual assessments of findings were mostly high (n = 21, 58%) or moderate (n = 12, 33%) confidence with three (8%) low or very low confidence. Poorly managed, moderate or severe chronic non-cancer pain had profound adverse impacts on family dynamics and relationships; family members' emotions, well-being, autonomy and sense of self-identity; parenting strategies; friendships and socialising; children's education and future employment prospects; and parental employment. Most children and parents understood chronic non-cancer pain as having an underlying biological cause and wanted curative treatment. However, families had difficulties seeking and obtaining support from health services to manage their child's pain and its impacts. Children and parents felt that healthcare professionals did not always listen to their experiences and expertise, or believe the child's pain. Some families repeatedly visited health services seeking a diagnosis and cure. Over time, some children and families gave up hope of effective treatment. Outcomes measured within trials and Cochrane Reviews of intervention effects did not include some outcomes of importance to children and families, including impacts of pain on the whole family and absence of pain. Cochrane Reviews have mainly neglected a holistic biopsychosocial approach, which specifies the interrelatedness of biological, psychological and social aspects of illness, when selecting outcome measures and considering how chronic pain management interventions work. AUTHORS' CONCLUSIONS We had high or moderate confidence in the evidence contributing to most review findings. Further research, especially into families' experiences of treatments and services, could strengthen the evidence for low or very low confidence findings. Future research should also explore families' experiences in low- to middle-income contexts; of pain treatments including opioid use in children, which remains controversial; and of social care services. We need development and testing of family-centred interventions and services acceptable to families. Future trials of children's chronic non-cancer pain interventions should include family-centred outcomes.
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Affiliation(s)
- Emma France
- NMAHP Research Unit, University of Stirling, Stirling, UK
| | - Isabelle Uny
- Institute of Social Marketing, University of Stirling, Stirling, UK
| | - Ruth Turley
- Development Directorate, Cochrane Central Executive, Cochrane, London, UK
| | - Katie Thomson
- Occupational Therapy, Human Nutrition & Dietetics, Glasgow Caledonian University, Glasgow, UK
| | - Jane Noyes
- Centre for Health-Related Research, Fron Heulog, Bangor University, Bangor, UK
| | - Abbie Jordan
- Department of Psychology, University of Bath, Bath, UK
- Bath Centre for Pain Research, University of Bath, Bath, UK
| | - Liz Forbat
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Line Caes
- Department of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK
| | - Mayara Silveira Bianchim
- NMAHP Research Unit, University of Stirling, Stirling, UK
- Centre for Population Health and Wellbeing Research, School of Medical and Health Sciences, Bangor University, Bangor, UK
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Bakir E, Briggs M, Mackintosh-Franklin C, Marshall M, Achaliwie F. Communication, information, involvement and decision making: A systematic scoping review of child-parent-nurse relationships during postoperative pain management. J Clin Nurs 2023. [PMID: 36841960 DOI: 10.1111/jocn.16655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/11/2022] [Accepted: 02/06/2023] [Indexed: 02/27/2023]
Abstract
AIMS To examine the existing literature on child-parent-nurse relationships (in relation to communication, information, and involvement and decision-making) during postoperative pain management. BACKGROUND Pain in children is under-reported and under-treated in hospitals and research has continued to report high rates of pain among hospitalised children worldwide. The role of child-parent-nurse relationships may be a factor and to date, no review has been identified that focus on these relationships during postoperative pain management. DESIGN A systematic scoping review following Arksey and O'Malley with further adaptations based on JBI. METHODS A systematic search for published primary studies was conducted using the Medline, CINAHL, British Nursing Index, ASSIA, PsycINFO, Science Direct and Web of Science in English from 2000 to 2022. Two reviewers independently carried out data screening and extraction and any differences were resolved with the assistance of a third reviewer. The data were analysed using thematic analysis and presented descriptively. This study followed the PRISMA-ScR Checklist. RESULTS A total of 37 studies met the inclusion criteria. The findings mainly demonstrated a focus on the perspectives of parents and nurses with less on children's perspectives and none of the studies explored child-nurse relationships. The findings were categorised under three themes: communication, information, and involvement and decision making. CONCLUSION A prevailing deficiency in child-parent-nurse relationships significantly contributed to suboptimal postoperative pain care, causing prolonged and untreated postoperative pain in children. Children's hesitation in communicating with nurses, the limited communication skills of nurses, and the weak communication position of parents in a hospital setting all hindered the development of strong relationships between children, parents, and nurses. The unclear definition of the roles of children and parents in postoperative pain management resulted in confusion for both parents and nurses. This was exacerbated by parents' lack of knowledge and inadequate guidance from nurses, ultimately leading to a decreased level of parental involvement in their child's postoperative pain management while in the hospital. Unattended requests for pain management caused children to experience prolonged pain and led to a deterioration in the relationship between parents and nurses, as well as a reduction in the parents' ability to provide pain care to their child. RELEVANCE TO CLINICAL PRACTICE This study highlights the reasons behind the suboptimal management of postoperative pain in children. The importance of the relationship between children, parents, and nurses in pain management must be acknowledged, and the results of this study may be used to inform improvements in nursing pain management practices. NO PATIENT OR PUBLIC CONTRIBUTION Patient or public contribution is not a necessary stage in a systematic scoping review following Arksey and O'Malley's framework.
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Affiliation(s)
- Ebru Bakir
- Department of Paediatric Nursing, Faculty of Health Science, Izmir Katip Celebi University, Izmir, Turkey
| | - Michelle Briggs
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Carolyn Mackintosh-Franklin
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Marie Marshall
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Francisca Achaliwie
- Department of Nursing, School of Nursing and Midwifery, CK Tedam University of Technology and Applied Sciences, Navrongo, Ghana
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Li T, Fu Y, Yang Y, Zhou YE. Control effect of virtual reality technology on procedural pain in children's wound: A meta-analysis. Medicine (Baltimore) 2022; 101:e30961. [PMID: 36221420 PMCID: PMC9542741 DOI: 10.1097/md.0000000000030961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Children who undergo wound manipulation usually experience pain. Virtual reality technology is a novel and effective non pharmaceutical therapy for reducing pain in children scheduled to undergo wound manipulation. However, the effectiveness of Virtual reality technology in controlling procedural pain in children's wounds has not been evaluated in a systematic review. METHODS It employed a meta-analysis design. We included studies with randomized controlled trials, reporting children's wound manipulation pain, and published them in English. Two reviewers independently evaluated the methodological quality of the included studies. RESULTS Of the 108 studies identified, 39 were eligible for the meta-analysis, with a total sample of 273 patients. The use of virtual reality technology has significantly reduced pain intensity during wound manipulation in children. There was a significant difference between the experimental group (virtual reality) and the control group (no virtual reality) in reducing the pain of the children's wound manipulation (P < .05). CONCLUSION As a distraction method of non drug assisted analgesia intervention, virtual reality technology can reduce children's procedural pain and discomfort symptoms.
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Affiliation(s)
- Tuan Li
- Yunnan University of Chinese Medicine, Kunming, Yunnan, People’s Republic of China
| | - Yingping Fu
- Yunnan University of Chinese Medicine, Kunming, Yunnan, People’s Republic of China
| | - Yanzheng Yang
- Yunnan University of Chinese Medicine, Kunming, Yunnan, People’s Republic of China
| | - Yu-E Zhou
- The Third People’s Hospital of Yunnan Province, Kunming, Yunnan, People’s Republic of China
- *Correspondence: Yu-e Zhou, The Third People’s Hospital of Yunnan Province, Kunming, Yunnan 650011, People’s Republic of China (e-mail: )
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Liu G, Zhang L, Wang HS, Lin Y, Jin HQ, Wang XD, Qiao WN, Zhang YT, Sun JQ, Liu ZN. Dexmededomidine in pediatric unilateral internal inguinal ring ligation. World J Clin Cases 2022; 10:7376-7385. [PMID: 36157988 PMCID: PMC9353900 DOI: 10.12998/wjcc.v10.i21.7376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/21/2022] [Accepted: 06/03/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Safe and effective analgesia strategy remains one of the priorities for pediatric inguinal hernia treatment.
AIM To explore safety and efficacy of dexmededomidine monotherapy for postoperative analgesia in children who received laparoscopic unilateral internal inguinal ring ligation.
METHODS This randomized single-center controlled trial included 390 children (aged 1-3 years, ASA grade I-II), randomly divided into a dexmededomidine group (D group), a dexmededomidine + sufentanil group (DS group), and a sufentanil group (S group). The primary endpoint was percentage of children with the Face, Legs, Activity, Cry, and Consolability (FLACC) score ≤ 3 points 2 h after surgery.
RESULTS The comparisons of the FLACC scores at 2, 4, 6, 8, 12, and 24 h were not significantly different among the three groups (P > 0.05). The sedative effects in the D group were significantly better than those in the S group (P > 0.05), but not significantly different from those in the DS group. The incidence of nausea and vomiting was significantly lower in the D group than in the S group and DS group (P > 0.05).
CONCLUSION Analgesic effects of dexmededomidine monotherapy are comparable to those of sufentanil alone or in combination with dexmededomidine for children who underwent laparoscopic unilateral internal inguinal ring ligation, with better sedative effects and a lower incidence of adverse events.
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Affiliation(s)
- Guang Liu
- Department of Anesthesiology, Baoding Children's Hospital, Baoding 071000, Hebei Province, China
| | - Ling Zhang
- Department of Anesthesiology, Baoding Children's Hospital, Baoding 071000, Hebei Province, China
| | - Hui-Se Wang
- Department of Anesthesiology, Baoding Children's Hospital, Baoding 071000, Hebei Province, China
| | - Yi Lin
- Department of Anesthesiology, Baoding Children's Hospital, Baoding 071000, Hebei Province, China
| | - Hong-Quan Jin
- Department of Anesthesiology, Baoding Children's Hospital, Baoding 071000, Hebei Province, China
| | - Xiao-Dan Wang
- Department of Anesthesiology, Baoding Children's Hospital, Baoding 071000, Hebei Province, China
| | - Wei-Na Qiao
- Department of Anesthesiology, Baoding Children's Hospital, Baoding 071000, Hebei Province, China
| | - Ya-Tao Zhang
- Department of Anesthesiology, Baoding Children's Hospital, Baoding 071000, Hebei Province, China
| | - Jiao-Qian Sun
- Department of Anesthesiology, Baoding Children's Hospital, Baoding 071000, Hebei Province, China
| | - Zhi-Na Liu
- Department of Anesthesiology, Baoding Children's Hospital, Baoding 071000, Hebei Province, China
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Matula ST, Irving SY, Deatrick JA, Steenhoff AP, Polomano RC. The perceptions and practices of parents and children on acute pain management among hospitalized children in two Botswana referral hospitals. J Pediatr Nurs 2022; 65:e35-e42. [PMID: 35190237 DOI: 10.1016/j.pedn.2022.02.004] [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: 10/20/2021] [Revised: 01/23/2022] [Accepted: 02/10/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Perceptions and practices of parties in pediatric pain are critical in children's access to adequate acute pain management. The personal factors of the child and parents have been shown to be central to pediatric pain management by the Symptom Management Theory. AIM To describe children and parents/guardians' perceptions (knowledge, attitudes and beliefs) and practices regarding pediatric acute pain management and explain the influence of socio-cultural and environmental factors on those perceptions and practices. METHODS Descriptive cross-sectional survey using modified versions of the American Pain Society Patient Outcome Questionnaire-Revised among parents/guardians and children. RESULTS A convenience sample of 275 parents/guardians and 42 children aged 8 to 13 years admitted between date November 2018 and February 2019 to two Botswana tertiary hospitals completed the surveys. Forty-seven percent (n = 129) of parents/guardians reported the child to be in moderate-severe pain, while 38% (n = 16) of children reported pain as moderate-severe at the time of the survey. The children mean scores for cm-APS-POQ-R were 113(33) while parents/guardian's guardians for m-APS-POQ-R were 123(26). The subscales except for the parents/'guardians' pain interference (p = .96) were statistically significant (p = .000), showing adequate knowledge, positive attitudes and high pain intensity for both parents/guardians and children. CONCLUSION Parent/guardians and children reported a high incidence of acute pain, were content with pain management services, and showed adequate knowledge of pediatric pain and its management. The incongruence between the intensity of pain, satisfaction on the adequacy of pain management and knowledge and attitudes demonstrated in this study need further inquiry.
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Affiliation(s)
- Samuel T Matula
- Faculty of Health Sciences, School of Nursing, University of Botswana, Gaborone, Botswana; University of Botswana, Block 246/A106, 4775 Notwane Road, Gaborone, Botswana. P/bag UB, 00712, Gaborone, Botswana.
| | - Sharon Y Irving
- Pediatric Nursing, University of Pennsylvania, Nurse Practitioner, Division of Anesthesiology and Critical Care Medicine/Critical Care Nursing. The Children's Hospital of Philadelphia.
| | | | - Andrew P Steenhoff
- Perelman School of Medicine, University of Pennsylvania; Medical Director, Global Health Center, The Children's Hospital of Philadelphia; & Adjunct Senior Lecturer, Department of Paediatric and Adolescent Health, Faculty of Medicine, University of Botswana.
| | - Rosemary C Polomano
- Professor of Pain Practice, School of Nursing, Professor of Anesthesiology and Critical Care, Perelman School of Medicine.
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Smith HAB, Besunder JB, Betters KA, Johnson PN, Srinivasan V, Stormorken A, Farrington E, Golianu B, Godshall AJ, Acinelli L, Almgren C, Bailey CH, Boyd JM, Cisco MJ, Damian M, deAlmeida ML, Fehr J, Fenton KE, Gilliland F, Grant MJC, Howell J, Ruggles CA, Simone S, Su F, Sullivan JE, Tegtmeyer K, Traube C, Williams S, Berkenbosch JW. 2022 Society of Critical Care Medicine Clinical Practice Guidelines on Prevention and Management of Pain, Agitation, Neuromuscular Blockade, and Delirium in Critically Ill Pediatric Patients With Consideration of the ICU Environment and Early Mobility. Pediatr Crit Care Med 2022; 23:e74-e110. [PMID: 35119438 DOI: 10.1097/pcc.0000000000002873] [Citation(s) in RCA: 142] [Impact Index Per Article: 71.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
RATIONALE A guideline that both evaluates current practice and provides recommendations to address sedation, pain, and delirium management with regard for neuromuscular blockade and withdrawal is not currently available. OBJECTIVE To develop comprehensive clinical practice guidelines for critically ill infants and children, with specific attention to seven domains of care including pain, sedation/agitation, iatrogenic withdrawal, neuromuscular blockade, delirium, PICU environment, and early mobility. DESIGN The Society of Critical Care Medicine Pediatric Pain, Agitation, Neuromuscular Blockade, and Delirium in critically ill pediatric patients with consideration of the PICU Environment and Early Mobility Guideline Taskforce was comprised of 29 national experts who collaborated from 2009 to 2021 via teleconference and/or e-mail at least monthly for planning, literature review, and guideline development, revision, and approval. The full taskforce gathered annually in-person during the Society of Critical Care Medicine Congress for progress reports and further strategizing with the final face-to-face meeting occurring in February 2020. Throughout this process, the Society of Critical Care Medicine standard operating procedures Manual for Guidelines development was adhered to. METHODS Taskforce content experts separated into subgroups addressing pain/analgesia, sedation, tolerance/iatrogenic withdrawal, neuromuscular blockade, delirium, PICU environment (family presence and sleep hygiene), and early mobility. Subgroups created descriptive and actionable Population, Intervention, Comparison, and Outcome questions. An experienced medical information specialist developed search strategies to identify relevant literature between January 1990 and January 2020. Subgroups reviewed literature, determined quality of evidence, and formulated recommendations classified as "strong" with "we recommend" or "conditional" with "we suggest." Good practice statements were used when indirect evidence supported benefit with no or minimal risk. Evidence gaps were noted. Initial recommendations were reviewed by each subgroup and revised as deemed necessary prior to being disseminated for voting by the full taskforce. Individuals who had an overt or potential conflict of interest abstained from relevant votes. Expert opinion alone was not used in substitution for a lack of evidence. RESULTS The Pediatric Pain, Agitation, Neuromuscular Blockade, and Delirium in critically ill pediatric patients with consideration of the PICU Environment and Early Mobility taskforce issued 44 recommendations (14 strong and 30 conditional) and five good practice statements. CONCLUSIONS The current guidelines represent a comprehensive list of practical clinical recommendations for the assessment, prevention, and management of key aspects for the comprehensive critical care of infants and children. Main areas of focus included 1) need for the routine monitoring of pain, agitation, withdrawal, and delirium using validated tools, 2) enhanced use of protocolized sedation and analgesia, and 3) recognition of the importance of nonpharmacologic interventions for enhancing patient comfort and comprehensive care provision.
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Affiliation(s)
- Heidi A B Smith
- Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN
- Division of Pediatric Cardiac Anesthesiology, Vanderbilt University Medical Center, Department of Anesthesiology, Nashville, TN
| | - James B Besunder
- Division of Pediatric Critical Care, Akron Children's Hospital, Akron, OH
- Department of Pediatrics, Northeast Ohio Medical University, Akron, OH
| | - Kristina A Betters
- Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN
| | - Peter N Johnson
- University of Oklahoma College of Pharmacy, Oklahoma City, OK
- The Children's Hospital at OU Medical Center, Oklahoma City, OK
| | - Vijay Srinivasan
- Departments of Anesthesiology, Critical Care, and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Anne Stormorken
- Pediatric Critical Care, Rainbow Babies Children's Hospital, Cleveland, OH
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH
| | - Elizabeth Farrington
- Betty H. Cameron Women's and Children's Hospital at New Hanover Regional Medical Center, Wilmington, NC
| | - Brenda Golianu
- Division of Pediatric Anesthesia and Pain Management, Department of Anesthesiology, Lucile Packard Children's Hospital, Palo Alto, CA
- Department of Anesthesiology, Stanford University School of Medicine, Palo Alto, CA
| | - Aaron J Godshall
- Department of Pediatrics, AdventHealth For Children, Orlando, FL
| | - Larkin Acinelli
- Division of Critical Care Medicine, Johns Hopkins All Children's Hospital, St Petersburg, FL
| | - Christina Almgren
- Lucile Packard Children's Hospital Stanford Pain Management, Palo Alto, CA
| | | | - Jenny M Boyd
- Division of Pediatric Critical Care, N.C. Children's Hospital, Chapel Hill, NC
- Division of Pediatric Critical Care, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Michael J Cisco
- Division of Pediatric Critical Care Medicine, UCSF Benioff Children's Hospital San Francisco, San Francisco, CA
| | - Mihaela Damian
- Lucile Packard Children's Hospital Stanford at Stanford Children's Health, Palo Alto, CA
- Division of Pediatric Critical Care Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Mary L deAlmeida
- Children's Healthcare of Atlanta at Egleston, Atlanta, GA
- Division of Pediatric Critical Care, Emory University School of Medicine, Atlanta, GA
| | - James Fehr
- Department of Anesthesiology, Stanford University School of Medicine, Palo Alto, CA
- Department of Anesthesiology, Lucile Packard Children's Hospital, Palo Alto, CA
| | | | - Frances Gilliland
- Division of Cardiac Critical Care, Johns Hopkins All Children's Hospital, St Petersburg, FL
- College of Nursing, University of South Florida, Tampa, FL
| | - Mary Jo C Grant
- Primary Children's Hospital, Pediatric Critical Care Services, Salt Lake City, UT
| | - Joy Howell
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Weill Cornell Medical College, New York, NY
| | | | - Shari Simone
- University of Maryland School of Nursing, Baltimore, MD
- Pediatric Intensive Care Unit, University of Maryland Medical Center, Baltimore, MD
| | - Felice Su
- Lucile Packard Children's Hospital Stanford at Stanford Children's Health, Palo Alto, CA
- Division of Pediatric Critical Care Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Janice E Sullivan
- "Just For Kids" Critical Care Center, Norton Children's Hospital, Louisville, KY
- Division of Pediatric Critical Care, University of Louisville School of Medicine, Louisville, KY
| | - Ken Tegtmeyer
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Chani Traube
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Weill Cornell Medical College, New York, NY
| | - Stacey Williams
- Division of Pediatric Critical Care, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, TN
| | - John W Berkenbosch
- "Just For Kids" Critical Care Center, Norton Children's Hospital, Louisville, KY
- Division of Pediatric Critical Care, University of Louisville School of Medicine, Louisville, KY
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Davison G, Kelly MA, Conn R, Thompson A, Dornan T. How do children and adolescents experience healthcare professionals? Scoping review and interpretive synthesis. BMJ Open 2021; 11:e054368. [PMID: 34244289 PMCID: PMC8273482 DOI: 10.1136/bmjopen-2021-054368] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 06/22/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Explore children's and adolescents' (CADs') lived experiences of healthcare professionals (HCPs). DESIGN Scoping review methodology provided a six-step framework to, first, identify and organise existing evidence. Interpretive phenomenology provided methodological principles for, second, an interpretive synthesis of the life worlds of CADs receiving healthcare, as represented by verbatim accounts of their experiences. DATA SOURCES Five key databases (Ovid Medline, Embase, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus, and Web of Science), from inception through to January 2019, reference lists, and opportunistically identified publications. ELIGIBILITY CRITERIA Research articles containing direct first-person quotations by CADs (aged 0-18 years inclusive) describing how they experienced HCPs. DATA EXTRACTION AND SYNTHESIS Tabulation of study characteristics, contextual information, and verbatim extraction of all 'relevant' (as defined above) direct quotations. Analysis of basic scope of the evidence base. The research team worked reflexively and collaboratively to interpret the qualitative data and construct a synthesis of children's experiences. To consolidate and elaborate the interpretation, we held two focus groups with inpatient CADs in a children's hospital. RESULTS 669 quotations from 99 studies described CADs' experiences of HCPs. Favourable experiences were of forming trusting relationships and being involved in healthcare discussions and decisions; less favourable experiences were of not relating to or being unable to trust HCPs and/or being excluded from conversations about them. HCPs fostered trusting relationships by being personable, wise, sincere and relatable. HCPs made CADs feel involved by including them in conversations, explaining medical information, and listening to CADs' wider needs and preferences. CONCLUSION These findings strengthen the case for making CADs partners in healthcare despite their youth. We propose that a criterion for high-quality child-centred healthcare should be that HCPs communicate in ways that engender trust and involvement.
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Affiliation(s)
- Gail Davison
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
- Children's Emergency Department, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Martina Ann Kelly
- Department of Family Medicine, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada
| | - Richard Conn
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
- General Paediatrics Department, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Andrew Thompson
- General Paediatrics Department, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Tim Dornan
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
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Pediatric Pain Management Knowledge Levels of Intern Nursing Students. Pain Manag Nurs 2020; 21:290-298. [DOI: 10.1016/j.pmn.2019.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 04/16/2019] [Accepted: 06/18/2019] [Indexed: 11/22/2022]
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Noble F, Kettle J, Hulin J, Morgan A, Rodd H, Marshman Z. '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. Dent J (Basel) 2020; 8:dj8020050. [PMID: 32414081 PMCID: PMC7345760 DOI: 10.3390/dj8020050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/20/2020] [Accepted: 05/11/2020] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Fiona Noble
- Charles Clifford Dental Hospital, Sheffield S10 2SZ, UK
- School of Clinical Dentistry, University of Sheffield, Sheffield S10 2TA, UK; (J.K.); (A.M.); (H.R.); (Z.M.)
- Correspondence:
| | - Jennifer Kettle
- School of Clinical Dentistry, University of Sheffield, Sheffield S10 2TA, UK; (J.K.); (A.M.); (H.R.); (Z.M.)
| | - Joe Hulin
- Mental Health Research Unit, School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK;
| | - Annie Morgan
- School of Clinical Dentistry, University of Sheffield, Sheffield S10 2TA, UK; (J.K.); (A.M.); (H.R.); (Z.M.)
| | - Helen Rodd
- School of Clinical Dentistry, University of Sheffield, Sheffield S10 2TA, UK; (J.K.); (A.M.); (H.R.); (Z.M.)
| | - Zoe Marshman
- School of Clinical Dentistry, University of Sheffield, Sheffield S10 2TA, UK; (J.K.); (A.M.); (H.R.); (Z.M.)
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10
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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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11
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Coleman LN, Wathen K, Waldron M, Mason JJ, Houston S, Wang Y, Hinds PS. The Child's Voice in Satisfaction with Hospital Care. J Pediatr Nurs 2020; 50:113-120. [PMID: 31812854 DOI: 10.1016/j.pedn.2019.11.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/15/2019] [Accepted: 11/15/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Patient satisfaction is a quality improvement indicator used to evaluate care. Ratings of patient satisfaction in pediatrics exclude the child voice. We tested the feasibility and acceptability of a new model that included both child and parent satisfaction ratings. DESIGN AND METHODS We executed a randomized, two-arm, unblinded cohort study comparing child (aged 7-17 years) and parent reports (Arm 1) to parent report only (Arm 2) among a convenience sample of inpatients at a single urban pediatric medical center. The primary (feasibility and acceptability) and secondary outcomes were assessed at the time of discharge (T1) and approximately 10 days following discharge (T2) (standard timing). RESULTS Of 672 screened families, 89.3% (n = 600) enrolled in the study; 362 children and parents were randomized to Arm 1 and 238 parents to Arm 2. Patients (98.6%) and parents (99.8%) indicated preference for providing satisfaction ratings at the time of discharge. Seventy-five percent of families (n = 488) completed T1 and T2; neither child nor parent ratings differed significantly between T1 and T2 nor did parent ratings differ between the two study arms. Nurse friendliness, courtesy, and feeling well cared for were among the highest rated items at T1 and T2 by both children and parents. CONCLUSIONS Children 7 to 17 years of age and their parents are willing and like to provide satisfaction with care ratings prior to hospital discharge. PRACTICE IMPLICATIONS This measurement model could yield valid findings representative of hospitalized children and their parents, and could become the basis for a new and needed measurement approach for pediatric satisfaction with hospital care.
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Affiliation(s)
- Lael N Coleman
- Department of Nursing Science, Professional Practice, and Quality, Children's National Hospital, Washington, D.C. United States of America
| | - Kourtney Wathen
- Department of Nursing Science, Professional Practice, and Quality, Children's National Hospital, Washington, D.C. United States of America
| | - Mia Waldron
- Department of Nursing Science, Professional Practice, and Quality, Children's National Hospital, Washington, D.C. United States of America
| | - Janice J Mason
- Department of Nursing Science, Professional Practice, and Quality, Children's National Hospital, Washington, D.C. United States of America
| | - Sasha Houston
- Patient Care Services, Children's National Hospital, Washington, D.C. United States of America
| | - Yunfei Wang
- Department of Biostatistics Children's National Hospital, Washington, D.C. United States of America; School of Medicine and Health Sciences, the George Washington University, United States of America
| | - Pamela S Hinds
- Department of Nursing Science, Professional Practice, and Quality, Children's National Hospital, Washington, D.C. United States of America; School of Medicine and Health Sciences, the George Washington University, United States of America.
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12
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Ebrahimpour F, Pashaeypoor S, Salisu WJ, Cheraghi MA, Sadat Hosseini AS. Children's description of pain through drawings and dialogs: A concept analysis. Nurs Open 2019; 6:301-312. [PMID: 30918682 PMCID: PMC6419297 DOI: 10.1002/nop2.211] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 08/16/2018] [Accepted: 09/17/2018] [Indexed: 12/31/2022] Open
Abstract
AIM To present a concept analysis of pain in children's drawings and dialogs. INTRODUCTION The complexity and subjectivity of the concept of pain in children remain ambiguous. As a result, children are exposed to inappropriate diagnosis and inadequate treatment. Children can describe or draw their painful experiences. Analysing the concept of pain based on children's experiences can help identify, assess and properly manage and treat pain in children. DESIGN Concept analysis. METHODS Walker and Avant's framework for concept analysis was used in this current study. RESULTS Major aspects of pain revealed in this concept analysis are affected by children's different concerns about pain. The description of pain in children with chronic diseases or chronic pain is completely different from that in healthy children. Children perceive pain to be internal, external and emotional. Pain in children is associated with poor psychological and emotional conditions, which add new features and aspects to the concept of pain. Children's descriptions and drawings of pain indicate different concepts of pain in their minds. From the perspective of children, pain has an identity that is formed based on reality. CONCLUSION When developing pain evaluation tools, it is necessary to address the characteristics of pain. In the case of chronic pain, emotional effects of pain on children's psyche need extra attention. Child-based pain management guidelines can then be formulated with the results of relevant concept analyses. Pain assessment is a major part of pain management in children. By considering the characteristics of the concept of pain, the efficiency and usefulness of developed tools can be enhanced to create advancement in paediatric pain management.
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Affiliation(s)
- Fatemeh Ebrahimpour
- School of Nursing & MidwiferyTehran University of Medical SciencesTehranIran
| | - Shahzad Pashaeypoor
- School of Nursing & MidwiferyTehran University of Medical SciencesTehranIran
| | - Waliu Jawula Salisu
- School of Nursing & MidwiferyTehran University of Medical SciencesTehranIran
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13
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Gunes A, Bramhagen AC. Heparin or Sodium Chloride for Prolonging Peripheral Intravenous Catheter Use in Children - A Systematic Review. J Pediatr Nurs 2018; 43:e92-e99. [PMID: 30098834 DOI: 10.1016/j.pedn.2018.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 07/31/2018] [Accepted: 08/02/2018] [Indexed: 01/06/2023]
Abstract
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.
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Affiliation(s)
- Aynur Gunes
- Department of Paediatrics, Skåne University Hospital, Malmö, Sweden
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14
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Matula ST, Polomano RC, Irving SY. The state of the science in paediatric pain management practices in low-middle income countries: An integrative review. Int J Nurs Pract 2018; 24:e12695. [PMID: 30251308 DOI: 10.1111/ijn.12695] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 06/30/2018] [Indexed: 12/31/2022]
Abstract
AIM Examine the state of the science for pain management in children living in low-middle income countries (LMIC). BACKGROUND Significant challenges exist in pain management for children living in LMIC. METHODS An integrative review was conducted using PRISMA guidelines for quality of reporting. Literature searches were completed using Medline, PubMed, Scopus, and CINAHL databases for publications between January 2006 and August 2016 using MeSH and primary search terms pain and LMIC. Full text publications were evaluated using GRADE criterion and methodology specific evaluation tools. RESULTS Of 1510 publications identified, 31 met the criteria for inclusion. Data were categorized into three broad themes: (1) magnitude of the pain problem with subthemes describing the burden of and resources for paediatric pain management; (2) perceptions, experience, and practices for managing pain in children residing in LMIC with subthemes addressing health care providers, parent/caregiver and children, respectively; and (3) pain management practices with pain assessment and treatment strategies as subthemes. CONCLUSION Current data on paediatric pain management in LMIC are limited with respect to describing the burden of pain, children's pain perceptions and experiences, and pain management practices. Rigorous investigations are needed to expand knowledge and address the pervasive problem of pain for children in LMIC.
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Affiliation(s)
- Samuel T Matula
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Rosemary C Polomano
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA.,University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Sharon Y Irving
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA.,Division of Anesthesiology and Critical Care Medicine/Critical Care Nursing, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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15
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Pope N, Tallon M, Leslie G, Wilson S. Ask me: Children's experiences of pain explored using the draw, write, and tell method. J SPEC PEDIATR NURS 2018; 23:e12218. [PMID: 29790268 DOI: 10.1111/jspn.12218] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 04/03/2018] [Accepted: 04/25/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE Pain management within emergency departments (ED) remains challenging. Given that unrelieved pain in children is linked to a number of negative physiological and psychological consequences, optimal management of children's pain is paramount. Many studies exploring children's pain have adopted quantitative methods or sought the perspectives of adults. Compared to adults, studies examining children's views on pain and pain management are limited. This study aimed to explore children's pain experiences, their perception of pain management and expectations of the role of the nurse. DESIGN This was a qualitative descriptive study using an inductive approach. METHODS Fifteen children, aged 4-8 years who presented to the ED of an Australian tertiary pediatric hospital in acute pain participated. Data were collected using draw, write, and tell (DWT) technique and analyzed using thematic analysis. RESULTS Three themes emerged (1) "Security," (2) "My pain" with subthemes: "The pain feelings" and "My sad/happy feelings," (3) "Comfort and relief" with subthemes: "Taking my mind off it," "Resting" and "Hospital things." When in pain children needed to feel secure. Parents and nurses were important in fostering a secure environment for children. Children were capable of describing their pain and identified nonpharmacological strategies to help their pain. PRACTICE IMPLICATIONS Children as young as 4 years old can provide detailed accounts of their pain, which extends beyond physical dimensions to include visual, auditory, and sensory features. Nurses need to listen, be honest, and develop trust with children to be helpful. Nonpharmacological pain-relieving strategies can be implemented by parents and nurses in collaboration with the child. Fostering a secure environment is essential.
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Affiliation(s)
- Nicole Pope
- Child and Adolescent Health Service, Princess Margaret Hospital for Children, Perth, Australia.,West Australian Centre of Evidence Informed Healthcare Practice: a Joanna Briggs Institute Centre of Excellence, Curtin University, Perth, Australia.,School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
| | - Mary Tallon
- West Australian Centre of Evidence Informed Healthcare Practice: a Joanna Briggs Institute Centre of Excellence, Curtin University, Perth, Australia.,School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
| | - Gavin Leslie
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
| | - Sally Wilson
- Child and Adolescent Health Service, Princess Margaret Hospital for Children, Perth, Australia.,West Australian Centre of Evidence Informed Healthcare Practice: a Joanna Briggs Institute Centre of Excellence, Curtin University, Perth, Australia.,School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
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16
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Researching children's perspectives in pediatric palliative care: A systematic review and meta-summary of qualitative research. Palliat Support Care 2018; 17:107-118. [DOI: 10.1017/s1478951518000172] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveQualitative research is pivotal in gaining understanding of individuals’ experiences in pediatric palliative care. In the past few decades, the number of qualitative studies on pediatric palliative care has increased slightly, as has interest in qualitative research in this area. Nonetheless, a limited number of such studies have included the first-person perspective of children. The aim of this article is to understand the contribution of previous qualitative research on pediatric palliative care that included the voices of children.MethodA systematic review of qualitative studies and a meta-summary were conducted. MEDLINE, CINAHL, PsycINFO, PsycARTICLES, and ERIC were searched without limitations on publication date or language. Eligible articles were qualitative research articles in which the participants were children ranging in age from 3 to 18 years.ResultWe retrieved 16 qualitative research articles reporting on 12 unique studies, and we selected two mixed-method articles. The meta-summary shows eight themes: the relationship with professional caregivers, pain and its management, “living beyond pain,” the relationship between pediatric patients and their families, children's view on their treatment and service provision, meanings children give to their end-of-life situation, consequences of clinical decisions, and the relationships among children in pediatric palliative care and their peers.Significance of resultsThis meta-summary presents the “state of the art” of pediatric palliative care qualitative research on children and highlights additional research areas that warrant qualitative study.
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17
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Pain and its Impact on the Functional Ability in Children Treated at the Children's Cancer Center of Lebanon. J Pediatr Nurs 2018; 39:e11-e20. [PMID: 29338904 DOI: 10.1016/j.pedn.2017.12.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 12/08/2017] [Accepted: 12/11/2017] [Indexed: 11/23/2022]
Abstract
PURPOSE The purpose of this study was to describe the characteristics of pain in children under treatment at the Children Cancer Centre of Lebanon at the American University of Beirut Medical Centre. Design and Methods A cross-sectional correlational survey was used. The Adolescent Pediatric Pain Tool and the Functional Disability Inventory were used to examine the characteristics of pain experienced in a consecutive sample of children treated at the CCCL and its impact on their functional abilities. RESULTS The mean age of the 62 participants was 12.3 (SD 2.9). The overall mean pain intensity rating for the sample was 5.06 (SD 1.87) on a 10 cm Word Graphic Rating Scale. More than one-half of the children in the sample (57.4%) reported having pain "sometimes" with a median duration of two hours per pain episode. The most frequently reported locations of pain were the forehead, the abdomen, and the lower back. For the most part, the children used sensory words to describe their pain experience. The children reported moderate levels of functional disability (mean FDI score 25.04, SD 13.81). Multivariable linear regression analysis identified frequency, duration, location, use of affective descriptors, and treatments as statistically significant predictors of pain intensity. CONCLUSION Regrettably, the findings reported attest once again to unrelieved pain in a pediatric oncology population. PRACTICE IMPLICATIONS Policy makers can contribute to pain control by introducing legislation and national policies to ensure adequate pain management for children with cancer in Lebanon.
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18
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Pope N, Tallon M, McConigley R, Leslie G, Wilson S. Experiences of acute pain in children who present to a healthcare facility for treatment: a systematic review of qualitative evidence. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2017; 15:1612-1644. [PMID: 28628521 DOI: 10.11124/jbisrir-2016-003029] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
BACKGROUND Pain is a universal and complex phenomenon that is personal, subjective and specific. Despite growing knowledge in pediatric pain, management of children's pain remains sub-optimal and is linked to negative behavioral and physiological consequences later in life. As there is no synthesis of these studies, it was timely to undertake a systematic review. OBJECTIVES To identify, evaluate and synthesize the existing qualitative evidence on children's experiences of acute pain, including pain management, within a healthcare facility. INCLUSION CRITERIA TYPES OF PARTICIPANTS Children aged four to 18 years (inclusive) attending a healthcare facility who experienced acute pain associated with any injury, medical condition or treatment. PHENOMENA OF INTEREST Children's experiences and perceptions of their acute pain, pain management and expectations of others in managing their pain. Studies on children's experiences of pain in the postoperative context were excluded as a systematic review exploring this phenomenon had previously been published. Studies reporting on children's experiences of chronic pain were also excluded. CONTEXT Any healthcare facility including general practitioners' surgeries, hospitals, emergency departments and outpatient clinics. TYPES OF STUDIES Qualitative studies including phenomenology, grounded theory, ethnography, action research and feminist research designs. SEARCH STRATEGY Using a three-step search strategy, databases were searched in December 2015 to identify both published and unpublished articles from 2000 to 2015. Studies published in languages other than English were excluded. METHODOLOGICAL QUALITY All studies that met the inclusion criteria were assessed by at least two independent reviewers for methodological quality using a standardized critical appraisal tool from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). DATA EXTRACTION Data were extracted from the papers included in the review using standardized data extraction tool from JBI-QARI. DATA SYNTHESIS Findings were pooled using JBI-QARI. Findings were rated according to their level of credibility and categorized based on similarity in meaning and then were subjected to a meta-synthesis. RESULTS Four studies were included in this review. Two meta-syntheses were generated from five categories based on 21 findings: first, children can express their pain experiences in terms of cause, location, meaning and quality. Children's pain experiences include both physical and psychological dimensions. Children's pain experiences are influenced by their previous pain experiences, pain expectations and sociocultural factors. Second, children use a range of cognitive/behavioral and sensory/physical self-soothing strategies not only to help manage their pain, but also rely on the actions and presence of others as helpers when they are in pain. CONCLUSION Children's pain is a multi-dimensional complex phenomenon relying upon a multi-modal approach to management. Children as young as four years are capable of articulating their pain in terms of location, intensity and depth. The way children perceive, express and respond to pain is shaped by sociocultural factors, previous pain experiences and their expectations of pain. Children, parents and healthcare professionals play an important role in managing children's pain experiences.
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Affiliation(s)
- Nicole Pope
- 1Princess Margaret Hospital for Children, Child and Adolescent Health Service, Perth, Australia 2The Western Australian Group for Evidence Informed Healthcare Practice: a Joanna Briggs Institute Centre of Excellence, Curtin University, Perth, Australia 3School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia 4School of Public Health, Curtin University, Perth, Australia
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19
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Simons J. A Proposed Model of the Effective Management of Children's Pain. Pain Manag Nurs 2016; 16:570-8. [PMID: 26256220 DOI: 10.1016/j.pmn.2014.10.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 10/20/2014] [Accepted: 10/21/2014] [Indexed: 11/30/2022]
Abstract
The aim of this study was to understand the various factors that contribute to the delivery of effective pain management. The current picture of pain management is complex and contradictory, with children in the hospital still experiencing unnecessary pain, nurses reporting better pain care than is evidenced, and parents who are reluctant to report their child's pain. There is a real need to focus on areas of excellence where pain management innovations have been successfully implemented. Five hospitals were visited in three countries: the United Kingdom, Sweden, and Australia, spending a week in each country. In all, 28 health care professionals were interviewed exploring innovations in pain management; the effect of improvements on children, parents, and nurses; and what helped and hindered the delivery of effective pain management. Better pain management provides nurses with confidence, which in turn gives children and parents confidence in their care and reduces anxiety for nurses. Resources, on the other hand, were a common issue in relation to obstacles to innovation. A recurring theme in all areas visited was the issue of culture and how it affected both negatively and positively on the management of children's pain. Strong leadership was integral to moving practice forward and to introducing the innovations that led to effective pain management. The key findings identified that underpin the effective management of children's pain are effective leadership, resources, and confidence; the consequences are less stress for children and nurses, more trusting relationships, and greater job satisfaction. A model of effective pain management is proposed.
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Affiliation(s)
- Joan Simons
- Health and Social Care, The Open University, Milton Keynes, United Kingdom.
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20
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Karlsson K, Dalheim Englund AC, Enskär K, Nyström M, Rydström I. Experiencing Support During Needle-Related Medical Procedures: A Hermeneutic Study With Young Children (3-7Years). J Pediatr Nurs 2016; 31:667-677. [PMID: 27426015 DOI: 10.1016/j.pedn.2016.06.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 06/15/2016] [Accepted: 06/17/2016] [Indexed: 01/20/2023]
Abstract
UNLABELLED 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.
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Affiliation(s)
- Katarina Karlsson
- Faculty of Caring Sciences, Work Life and Social Welfare, University of Borås, Borås, Sweden.
| | | | - Karin Enskär
- Department of Nursing Sciences, CHILD Research Group, School of Health Sciences, Jönköping University, Jönköping, Sweden
| | - Maria Nyström
- Faculty of Caring Sciences, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Ingela Rydström
- Faculty of Caring Sciences, Work Life and Social Welfare, University of Borås, Borås, Sweden
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21
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Richardson C, Ovens E. Therapeutic opportunities when using vapocoolants for cannulation in children. ACTA ACUST UNITED AC 2016; 25:S23-7. [DOI: 10.12968/bjon.2016.25.14.s23] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Cliff Richardson
- Senior Lecturer, School of nursing, midwifery and social work, University of Manchester
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22
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Karlsson K, Rydström I, Nyström M, Enskär K, Dalheim Englund AC. Consequences of Needle-Related Medical Procedures: A Hermeneutic Study With Young Children (3-7 Years). J Pediatr Nurs 2016; 31:e109-18. [PMID: 26603292 DOI: 10.1016/j.pedn.2015.09.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 09/08/2015] [Accepted: 09/16/2015] [Indexed: 02/07/2023]
Abstract
UNLABELLED Needle-related medical procedures (NRMPs) are often frightening and cause children anxiety and pain. Only a few studies have examined the perspectives of younger children. More knowledge is needed about younger children's experiences in caring situations such as NRMPs. AIM The aim of this study was to explain and understand the consequences related to NRMPs from younger children's perspectives. METHODS Participant observations and interviews with younger children who had experienced NRMPs were analysed using a lifeworld hermeneutic approach. RESULTS Experiencing fear is central for younger children during an NRMP and interpretation of its consequences formed the basis for the following themes: seeking security, realizing the adult's power, struggling for control, feeling ashamed, and surrendering. A comprehensive understanding is presented wherein younger children's experiences of NRMPs vary across time and space related to weakening and strengthening their feelings of fear. CONCLUSIONS Awareness is needed that adults' power becomes more obvious for children during an NRMP. Children's surrender does not necessarily imply acceptance of the procedure. Providing children with opportunities to control elements of the procedure creates a foundation for active participation, and vice versa.
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Affiliation(s)
- Katarina Karlsson
- Faculty of Caring Sciences, Work Life and Social Welfare, University of Borås, Borås, Sweden; Department of Nursing Sciences, CHILD Research Group, School of Health Sciences, Jönköping University, Gjuterigatan 5, Jönköping, Sweden.
| | - Ingela Rydström
- Faculty of Caring Sciences, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Maria Nyström
- Faculty of Caring Sciences, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Karin Enskär
- Department of Nursing Sciences, CHILD Research Group, School of Health Sciences, Jönköping University, Gjuterigatan 5, Jönköping, Sweden
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Sims-Gould J, Race D, Hamilton L, MacDonald H, Mulpuri K, McKay H. 'I fell off and landed badly': Children's experiences of forearm fracture and injury prevention. J Child Health Care 2016; 20:98-108. [PMID: 25326540 PMCID: PMC5059151 DOI: 10.1177/1367493514551311] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Forearm fractures are one of the most common injuries sustained by children. Our descriptive study addressed, from the perspective of a child, the following research objectives: (1) to describe their fracture experience and (2) to describe how fractures might be prevented. Photovoice is a unique research strategy by which people create and discuss photographs. This technique has been used to elicit the perspectives of those whose voices are often 'not heard' in research, like children. Participants were recruited from a larger three-year prospective trial and included 10 boys (12.3 ± 1.6 years) and 7 girls (11.3 ± 1.6 years). We asked participants to take pictures to explain where their injury occurred (place), what they were doing at the time (context) and how the fracture had happened (mechanism). We also used semi-structured interview techniques. The following key themes emerged from our interviews: (1) the built environment as a key factor that 'caused' their fracture, (2) the fracture experienced as a journey not an event and (3) strategies to prevent fractures. A simple clinical step to potentially reduce subsequent fractures will be for clinicians to have a brief conversation with their young patients and to listen to the child's personal preventive strategies.
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Affiliation(s)
- Joanie Sims-Gould
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Douglas Race
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Heather MacDonald
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada Child and Family Research Institute, Vancouver, British Columbia, Canada
| | - Kishore Mulpuri
- Department of Orthopaedic Surgery, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Heather McKay
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
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Thrane SE, Wanless S, Cohen SM, Danford CA. The Assessment and Non-Pharmacologic Treatment of Procedural Pain From Infancy to School Age Through a Developmental Lens: A Synthesis of Evidence With Recommendations. J Pediatr Nurs 2016; 31:e23-32. [PMID: 26424196 PMCID: PMC4724566 DOI: 10.1016/j.pedn.2015.09.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 08/13/2015] [Accepted: 09/01/2015] [Indexed: 12/28/2022]
Abstract
UNLABELLED The 2011 IOM report stated that pain management in children is often lacking especially during routine medical procedures. The purpose of this review is to bring a developmental lens to the challenges in assessment and non-pharmacologic treatment of pain in young children. METHOD A synthesis of the findings from an electronic search of PubMed and the university library using the keywords pain, assessment, treatment, alternative, complementary, integrative, infant, toddler, preschool, young, pediatric, and child was completed. A targeted search identified additional sources for best evidence. RESULTS Assessment of developmental cues is essential. For example, crying, facial expression, and body posture are behaviors in infancy that indicate pain: however in toddlers these same behaviors are not necessarily indicative of pain. Preschoolers need observation scales in combination with self-report while for older children self-report is the gold standard. Pain management in infants includes swaddling and sucking. However for toddlers, preschoolers and older children, increasingly sophisticated distraction techniques such as easily implemented non-pharmacologic pain management strategies include reading stories, watching cartoons, or listening to music. DISCUSSION A developmental approach to assessing and treating pain is critical. Swaddling, picture books, or blowing bubbles are easy and effective when used at the appropriate developmental stage and relieve both physical and emotional pain. Untreated pain in infants and young children may lead to increased pain perception and chronic pain in adolescents and adults. Continued research in the non-pharmacological treatment of pain is an important part of the national agenda.
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Affiliation(s)
- Susan E. Thrane
- Assistant Professor, College of Nursing, Ohio State University, 322 Newton Hall, 1585 Neil Avenue, Columbus, OH 43210
| | - Shannon Wanless
- Assistant Professor, School of Education, University of Pittsburgh, 5937 Wesley W. Posvar Hall, 230 South Bouquet Street, Pittsburgh, PA 15260
| | - Susan M. Cohen
- Associate Professor, School of Nursing, University of Pittsburgh, 440 Victoria Building, 3500 Victoria Street, Pittsburgh, PA 15261
| | - Cynthia A. Danford
- Assistant Professor, School of Nursing, University of Pittsburgh, 458 Victoria Building, 3500 Victoria Street, Pittsburgh, PA 15261
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Olshansky E, Zender R, Kain ZN, Rosales A, Guadarrama J, Fortier MA. Hispanic parents' experiences of the process of caring for a child undergoing routine surgery: a focus on pain and pain management. J SPEC PEDIATR NURS 2015; 20:165-77. [PMID: 25816910 DOI: 10.1111/jspn.12111] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 02/27/2015] [Accepted: 03/02/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose was to understand the processes Hispanic parents undergo in managing postoperative care of children after routine surgical procedures. DESIGN AND METHODS Sixty parents of children undergoing outpatient surgery were interviewed. Data were analyzed using grounded theory methodology. RESULTS Parents experienced five subprocesses that comprised the overall process of caring for a child after routine surgery: (a) becoming informed; (b) preparing; (c) seeking reassurance; (d) communicating with one's child; and (e) making pain management decisions. PRACTICE IMPLICATIONS Addressing cultural factors related to pain management in underserved families may instill greater confidence in managing pain.
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Affiliation(s)
- Ellen Olshansky
- Program in Nursing Science, University of California, Irvine, California, USA.,Community Engagement, Institute for Clinical and Translational Science, University of California, Irvine, California, USA
| | - Robynn Zender
- Institute for Clinical and Translational Science, University of California, Irvine, California, USA
| | - Zeev N Kain
- Department of Anesthesiology & Perioperative Care, University of California, Irvine School of Medicine, Irvine, California, USA
| | - Alvina Rosales
- Department of Anesthesiology & Perioperative, University of California, Irvine School of Medicine, Irvine, California, USA
| | | | - Michelle A Fortier
- Department of Anesthesiology & Perioperative Care, University of California, Irvine School of Medicine, Orange, California, USA
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26
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He HG, Zhu L, Chan SWC, Klainin-Yobas P, Wang W. The Effectiveness of Therapeutic Play Intervention in Reducing Perioperative Anxiety, Negative Behaviors, and Postoperative Pain in Children Undergoing Elective Surgery: A Systematic Review. Pain Manag Nurs 2015; 16:425-39. [DOI: 10.1016/j.pmn.2014.08.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 08/09/2014] [Accepted: 08/11/2014] [Indexed: 01/01/2023]
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27
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He HG, Zhu L, Chan SWC, Liam JLW, Li HCW, Ko S, Klainin-Yobas P, Wang W. Therapeutic play intervention on children's perioperative anxiety, negative emotional manifestation and postoperative pain: a randomized controlled trial. J Adv Nurs 2015; 71:1032-43. [DOI: 10.1111/jan.12608] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2014] [Indexed: 12/21/2022]
Affiliation(s)
- Hong-Gu He
- Alice Lee Centre for Nursing Studies; National University of Singapore; Singapore
| | - Lixia Zhu
- Alice Lee Centre for Nursing Studies; National University of Singapore; Singapore
| | - Sally Wai-Chi Chan
- School of Nursing and Midwifery; The University of Newcastle; Callaghan New South Wales Australia
| | | | | | - Saw Sandar Ko
- Alice Lee Centre for Nursing Studies; National University of Singapore; Singapore
| | | | - Wenru Wang
- Alice Lee Centre for Nursing Studies; National University of Singapore; Singapore
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28
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Tyson ME, Bohl DD, Blickman JG. A randomized controlled trial: child life services in pediatric imaging. Pediatr Radiol 2014; 44:1426-32. [PMID: 24801818 DOI: 10.1007/s00247-014-3005-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 02/24/2014] [Accepted: 04/10/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Children undergoing procedures in pediatric health care facilities and their families have been shown to benefit from psychosocial services and interventions such as those provided by a Certified Child Life Specialist (CCLS). The comprehensive impact of a CCLS in a pediatric imaging department is well recognized anecdotally but has not been examined in a prospective or randomized controlled fashion. OBJECTIVE We prospectively assessed the impact of a CCLS on parent satisfaction, staff satisfaction, child satisfaction, and parent and staff perceptions of child pain and distress in a pediatric imaging department. MATERIALS AND METHODS Eligible children between 1 and 12 years of age (n = 137) presenting to the pediatric imaging department for an imaging procedure were randomly assigned to an intervention or control arm. Those assigned to the intervention received the comprehensive services of a CCLS. The control group received standard of care, which did not include any child life services. Quantitative measures of satisfaction and perception of child pain and distress were assessed by parents and staff using a written 5-point Likert scale questionnaire after the imaging procedure. Children 4 and older were asked to answer 3 questions on a 3-point scale. RESULTS Statistically significant differences between the intervention and control groups were found in 19 out of 24 measures. Parents in the intervention group indicated higher satisfaction and a lower perception of their child's pain and distress. Staff in the intervention group indicated greater child cooperation and a lower perception of the child's pain and distress. Children in the intervention group indicated a better overall experience and less fear than those in the control group. CONCLUSION Child life specialists have a quantifiably positive impact on the care of children in imaging departments. Measures of parent satisfaction, staff satisfaction, child satisfaction, child pain and child distress are shown to be positively impacted by the services of a CCLS. These results have significant implications for hospitals striving to increase satisfaction, decrease costs and improve quality of care. In a health care landscape that is changing quickly and increasingly focused on the cost of care, future research should assess whether the core tenants of the child life profession support and contribute quantifiably to high-quality, cost-effective practices in health care.
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Affiliation(s)
- Mary E Tyson
- Pediatric Imaging Sciences, Golisano Children's Hospital at the University of Rochester Medical Center, Rochester, NY, USA,
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29
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Borghi CA, Rossato LM, Damião EBC, Guedes DMB, Silva EMRD, Barbosa SMDM, Polastrini RT. Living with pain: the experience of children and adolescents in palliative care. Rev Esc Enferm USP 2014; 48 Spec No:67-73. [DOI: 10.1590/s0080-623420140000600010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 07/06/2014] [Indexed: 11/22/2022] Open
Abstract
A qualitative study was conducted with semi-structured interviews with the aim of understanding the experience of children and adolescents under palliative care when managing pain daily and how they describe the intensity, quality and location of pain. We used Piaget’s theory of cognitive development as a theoretical framework and oral history as a methodological framework. We found four themes: describing pain; seeking a life closer to normality, despite pain and disease; using a variety of alternatives for pain control; and living with damaged physical appearance. Although pain is a limiting factor in the lives of children and adolescents, we found that they faced their daily pain and still had a life beyond pain and illness. In addition, we highlight the relevance of nurses’ understanding that effective management of pain in children is essential for a normal life and less suffering.
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30
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He HG, Klainin-Yobas P, Ang ENK, Sinnappan R, Pölkki T, Wang W. Nurses' provision of parental guidance regarding school-aged children's postoperative pain management: a descriptive correlational study. Pain Manag Nurs 2014; 16:40-50. [PMID: 24957816 DOI: 10.1016/j.pmn.2014.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Revised: 02/28/2014] [Accepted: 03/17/2014] [Indexed: 11/27/2022]
Abstract
Involving parents in children's pain management is essential to achieve optimal outcomes. Parents need to be equipped with sufficient knowledge and information. Only a limited number of studies have explored nurses' provision of parental guidance regarding the use of nonpharmacologic methods in children's pain management. This study aimed to examine nurses' perceptions of providing preparatory information and nonpharmacologic methods to parents, and how their demographics and perceived knowledge adequacy of these methods influence this guidance. A descriptive correlational study using questionnaire surveys was conducted to collect data from a convenience sample of 134 registered nurses working in seven pediatric wards of two public hospitals in Singapore. Descriptive statistics, independent-samples t test, and multiple linear regression were used to analyze the data. Most nurses provided various types of cognitive information to parents related to their children's surgery, whereas information about children's feelings was less often provided. Most nurses provided guidance to parents on positioning, breathing technique, comforting/reassurance, helping with activities of daily living, relaxation, and creating a comfortable environment. Nurses' provision of parental guidance on preparatory information and nonpharmacologic methods was significantly different between subgroups of age, education, parent or not, and perceived knowledge adequacy of nonpharmacologic methods. Nurses' perceived knowledge adequacy was the main factor influencing their provision of parental guidance. More attention should be paid to nurses who are younger, have less working experience, and are not parents. There is a need to educate nurses about nonpharmacologic pain relief methods to optimize their provision of parental guidance.
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Affiliation(s)
- Hong-Gu He
- Alice Lee Centre for Nursing Studies Department, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Piyanee Klainin-Yobas
- Alice Lee Centre for Nursing Studies Department, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Emily Neo Kim Ang
- Clinical and Oncology Nursing, National University Hospital, Singapore
| | | | - Tarja Pölkki
- Institute of Health Sciences, University of Oulu, Oulu, Finland
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies Department, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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31
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Twycross A, Finley GA. Nurses' aims when managing pediatric postoperative pain: is what they say the same as what they do? J SPEC PEDIATR NURS 2014; 19:17-27. [PMID: 24393225 DOI: 10.1111/jspn.12029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 01/15/2013] [Accepted: 02/17/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to explore nurses' aims when managing postoperative pain and whether reported aims reflect actual practices. DESIGN AND METHODS Participant observation was used to collect data regarding nurses' (n = 17) pain management practices. Nurses (n = 19) were asked: When managing postoperative pain, what is your overall aim? RESULTS Around half the participants (n = 10) aimed for patients to be comfortable while others aimed for a pain score of 2-3 (n = 7), or below 5 (n = 2). Observed practices matched aims for just more than half the participants (n = 9). PRACTICE IMPLICATIONS There is evidence of individual variation in practices. This may impact on the care provided.
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Affiliation(s)
- Alison Twycross
- Faculty of Health Social Care and Education, Kingston University and St. George's University of London, London, UK
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32
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Suffering indicators in terminally ill children from the parental perspective. Eur J Oncol Nurs 2013; 17:720-5. [DOI: 10.1016/j.ejon.2013.04.004] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 02/04/2013] [Accepted: 04/05/2013] [Indexed: 11/20/2022]
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He HG, Zhu L, Li HCW, Wang W, Vehviläinen-Julkunen K, Chan SWC. A randomized controlled trial of the effectiveness of a therapeutic play intervention on outcomes of children undergoing inpatient elective surgery: study protocol. J Adv Nurs 2013; 70:431-42. [DOI: 10.1111/jan.12234] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Hong Gu He
- Alice Lee Centre for Nursing Studies; Yong Loo Lin School of Medicine; National University of Singapore; Singapore
| | - Lixia Zhu
- Alice Lee Centre for Nursing Studies; Yong Loo Lin School of Medicine; National University of Singapore; Singapore
| | | | - Wenru Wang
- Alice Lee Centre for Nursing Studies; Yong Loo Lin School of Medicine; National University of Singapore; Singapore
| | - Katri Vehviläinen-Julkunen
- Department of Nursing Science; Faculty of Health Sciences; University of Eastern Finland; Kuopio Finland
| | - Sally Wai Chi Chan
- Alice Lee Centre for Nursing Studies; Yong Loo Lin School of Medicine; National University of Singapore; Singapore
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Chieng YJS, Chan WCS, Klainin-Yobas P, He HG. Perioperative anxiety and postoperative pain in children and adolescents undergoing elective surgical procedures: a quantitative systematic review. J Adv Nurs 2013; 70:243-55. [PMID: 23865442 DOI: 10.1111/jan.12205] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2013] [Indexed: 11/30/2022]
Abstract
AIMS To examine the relationship between perioperative anxiety and postoperative pain in children and adolescents undergoing elective surgical procedures and the differences in children's perioperative anxiety and postoperative pain among subgroups of demographics. BACKGROUND While anxiety and pain are regarded as two common problems experienced by children and adolescents perioperatively and the relationship between them has been reported in previous studies, there has been no review paper examining this phenomenon. DESIGN A quantitative systematic review. DATA SOURCES Nine electronic databases were searched for studies published in English from the inception date of the databases to December 2010, using various combinations of search terms of 'adolescents', 'anxiety', 'child', 'pain', 'surgery' and 'correlation/relationship'. REVIEW METHODS Using the Joanna Briggs Institute's comprehensive systematic review strategies, relevant studies were independently appraised and extracted by two reviewers using the standardized critical appraisal instruments and data extraction tool from Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument. RESULTS Ten studies were included in this review from 943 studies initially retrieved. Children and adolescents who had higher level of perioperative anxiety experienced a higher level of postoperative pain. Inconclusive evidence was found regarding differences of perioperative anxiety and postoperative pain between demographic subgroups of gender, age and past surgical experience. CONCLUSION Results of this review inform healthcare providers of the role perioperative anxiety plays on children's and adolescents' postoperative pain and indicate the need to use interventions to reduce perioperative anxiety and, therefore, optimize their postoperative pain management during the perioperative period.
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Twycross A, Finley GA. Children's and parents’ perceptions of postoperative pain management: a mixed methods study. J Clin Nurs 2013; 22:3095-108. [DOI: 10.1111/jocn.12152] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2012] [Indexed: 12/26/2022]
Affiliation(s)
- Alison Twycross
- Faculty of Health, Social Care and Education; Kingston University and St George's University of London; London UK
| | - G Allen Finley
- Anesthesia & Psychology; Dalhousie University; Halifax NS Canada
- Dr Stewart Wenning Chair in Pediatric Pain Management; IWK Health Centre; Halifax NS Canada
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36
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Wen SQ, Taylor BJ, Lixia Z, Hong-Gu H. Childrenʼs experiences of their postoperative pain management: a qualitative systematic review. ACTA ACUST UNITED AC 2013. [DOI: 10.11124/01938924-201311040-00001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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37
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Montoya-Juárez R, García-Caro MP, Calderón CC, Rio-Valle JS, Sorroche-Navarro C, Quintana FC. [Suffering in children experiencing a terminal disease: the perspective of parents and professionals]. Rev Esc Enferm USP 2013; 46:1300-5. [PMID: 23380770 DOI: 10.1590/s0080-62342012000600003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 02/24/2012] [Indexed: 11/22/2022] Open
Abstract
Situation diagnosis using exploratory and descriptive scientific methodology (participant observation with descriptive statistical treatment) in order to identify nursing' practices in the area of health promotion during a nursing child health consultation. The 31 consultations observed (n = 31) showed that the majority of observations occurred in children younger than 2 years being the most discussed topic feed with predominant use of expository methodology. There was also little use of informational support and when used relate to the themes of security and nutrition. Most providers raised questions and there was limited registration of the interaction between provider and child with an expenditure averaging of 23 minutes per consultation. Given the results and reflecting about them stands out as intervention the construction of a health promotion manual with the integration of theory and evidence of good practice in this area.
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38
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[Opinions and attitudes of clinical staff on systems for the assessment and treatment of children's pain]. An Pediatr (Barc) 2013; 79:95-100. [PMID: 23375816 DOI: 10.1016/j.anpedi.2012.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 12/13/2012] [Accepted: 12/16/2012] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Many factors affect the assessment and treatment of pain, among them being the knowledge and attitudes of clinical staff. The goal of this work was to determine the opinions and attitudes of clinical staff from two hospitals on the different aspects of the assessment and treatment of children's pain. METHOD A cross-sectional, descriptive study was conducted using a self-administered questionnaire issued to clinical staff. The questionnaire was given to the professionals, doctors, and nursing staff of the paediatric services of two hospitals, and to an incidental sample of paediatric doctors. RESULTS Of the 146 questionnaires sent out, 105 were completed. Participants indicated that standardised scales and physiological recordings were the least frequently used methods to assess children's pain. Participants considered that pharmacological techniques for the treatment of pain were used more frequently than non-pharmacological techniques, at all ages. Participants acknowledged being significantly more knowledgeable about pharmacological methods to relieve paediatric pain than about non-pharmacological methods. CONCLUSIONS There is margin for improvement in systems for the assessment and treatment of children's pain as regards the more frequent and standardised use of techniques and standardised tools for the assessment of pain, and the greater administration of non-pharmacological strategies for its treatment.
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Sng QW, Taylor B, Liam JLW, Klainin-Yobas P, Wang W, He HG. Postoperative pain management experiences among school-aged children: a qualitative study. J Clin Nurs 2013; 22:958-68. [DOI: 10.1111/jocn.12052] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Qian Wen Sng
- Division of Nursing; KK Women's and Children's Hospital; Singapore
| | - Beverley Taylor
- School of Nursing and Midwifery; Monash University; Gippsland Victoria Australia
| | - Joanne LW Liam
- Division of Nursing; KK Women's and Children's Hospital; Singapore
| | - Piyanee Klainin-Yobas
- Alice Lee Centre for Nursing Studies; Yong Loo Lin School of Medicine; National University of Singapore; Singapore
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies; Yong Loo Lin School of Medicine; National University of Singapore; Singapore
| | - Hong-Gu He
- Alice Lee Centre for Nursing Studies; Yong Loo Lin School of Medicine; National University of Singapore; Singapore
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Voepel-Lewis T, Piscotty RJ, Annis A, Kalisch B. Empirical review supporting the application of the "pain assessment as a social transaction" model in pediatrics. J Pain Symptom Manage 2012; 44:446-57. [PMID: 22658250 DOI: 10.1016/j.jpainsymman.2011.09.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 09/28/2011] [Accepted: 10/05/2011] [Indexed: 11/28/2022]
Abstract
Despite decades of research, national mandates, and widespread implementation of guidelines, recent reports suggest that the quality of pain assessment and management in hospitalized children remains suboptimal. The mismatch between what is advocated and what is done in practice has led experts to argue for a conceptual shift in thinking, where the pain assessment process is viewed from a complex social communication or transaction framework. This article examines the empirical evidence from the recent pediatric pain assessment and decision-making literature that supports adaptation of Schiavenato and Craig's "Pain Assessment as a Social Transaction" model in explaining pediatric acute pain management decisions. Multiple factors contributing to children's pain experiences and expressions are explored, and some of the difficulties interpreting their pain scores are exposed. Gaps in knowledge related to nurses' clinical pain management decisions are identified, and the importance of children's and parents' preferences and roles and the influence of risks and adverse events on decision making are identified. This review highlights the complexity of pediatric nurses' pain management decisions toward the clinical goal of improving comfort while minimizing risk. Further study evaluating the propositions related to nurses' decisions to intervene is needed in pediatric clinical settings to better synthesize this model for children.
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Björkman B, Nilsson S, Sigstedt B, Enskär K. Children’s pain and distress while undergoing an acute radiographic examination. Radiography (Lond) 2012. [DOI: 10.1016/j.radi.2012.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Affiliation(s)
- David A Rosen
- Department of Anesthesia and Pediatrics, West Virginia University School of Medicine, WV, USA
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Czarnecki ML, Turner HN, Collins PM, Doellman D, Wrona S, Reynolds J. Procedural pain management: a position statement with clinical practice recommendations. Pain Manag Nurs 2011; 12:95-111. [PMID: 21620311 DOI: 10.1016/j.pmn.2011.02.003] [Citation(s) in RCA: 134] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 02/23/2011] [Accepted: 02/24/2011] [Indexed: 12/18/2022]
Abstract
The American Society for Pain Management Nursing (ASPMN) has developed a position statement and clinical practice recommendations related to procedural preparation and comfort management. Procedures potentially produce pain and anxiety, both of which should be assessed and addressed before the procedure begins. This position statement refers to "comfort management" as incorporating the management of pain, anxiety, and any other discomforts that may occur with procedures. It is the position of ASPMN that nurses and other health care professionals advocate and intervene based on the needs of the patient, setting, and situation, to provide optimal comfort management before, during, and after procedures. Furthermore, ASPMN does not condone procedures being performed without the implementation of planned comfort assessment and management. In addition to outlining this position with supporting evidence, this paper reviews the ethical considerations regarding procedural comfort management and provides recommendations for nonpharmacologic and pharmacologic management during all phases of the procedure. An appendix provides a summary of this position statement and clinical practice recommendations.
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Affiliation(s)
- Michelle L Czarnecki
- Jane B. Pettit Pain and Palliative Care Center, Children's Hospital of Wisconsin, Milwaukee, Wisconsin 53201, USA.
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Nilsson S, Hallqvist C, Sidenvall B, Enskär K. Children's experiences of procedural pain management in conjunction with trauma wound dressings. J Adv Nurs 2011; 67:1449-57. [PMID: 21332575 DOI: 10.1111/j.1365-2648.2010.05590.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM This paper is a report of the experiences of children (5-10 years) of procedural pain when they underwent a trauma wound care session. BACKGROUND Procedural pain in conjunction with trauma wound care often induces anxiety and distress in children. Children need to alleviate pain and avoid the development of fear in conjunction with examinations and treatments. The nurse could help children to reach this goal by using the comfort theory, which describes holistic nursing in four contexts: physical, psychospiritual, environmental and sociocultural. Few studies have focused on children's experiences of comforting activities in conjunction with trauma wound dressings. METHODS This study was conducted between May 2008 and January 2010. Thirty-nine participants aged 5-10 were consecutively included in this study. The wound care session was standardized for all the participants, and semi-structured qualitative interviews with open-ended questions were conducted with all the children in conjunction with the procedure. All the interviews were transcribed verbatim and analysed with qualitative content analysis. FINDINGS Four themes were identified: clinical competence, distraction, participation and security. The children were helped to reach comforting activities to enhance pain management. CONCLUSION Children require more than just analgesics in wound care. They also need to experience security and participation in this context. When children feel clinical competence in wound care, they trust the nurse to carry out the wound dressing and instead can focus on the distraction that increases their positive outcomes.
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Affiliation(s)
- Stefan Nilsson
- Department of Paediatric Anaesthesia and Intensive Care Unit, The Queen Silvia Children's Hospital, Göteborg, Sweden.
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Rullander AC, Isberg S, Karling M, Jonsson H, Lindh V. Adolescents' experience with scoliosis surgery: a qualitative study. Pain Manag Nurs 2010; 14:50-9. [PMID: 23452527 DOI: 10.1016/j.pmn.2010.07.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 07/14/2010] [Accepted: 07/14/2010] [Indexed: 11/19/2022]
Abstract
This article reports a study of adolescents' narrated experiences of undergoing scoliosis surgery. Six adolescents were interviewed. Open and semistructured questions were asked, and a qualitative content analysis of the text was performed. The results are presented in three main categories followed by subcategories. The three main categories of experience were emotional, physical, and social. The emotional aspects that emerged were fear, nightmares, nervousness, and helplessness. These had a great impact on adolescents' well-being before, during, and after the hospital visit. The physical aspects were mobilization, scars, different hip levels, pain, nausea, appetite, and urinary catheter. These aspects caused much discomfort, mostly during the hospital visit. The social aspects were friends, power, coaching and comfort, and sports. Some of the social aspects had a strong negative impact on the adolescents' well-being mostly after the hospital visit. This study suggests that both before and long after the surgery adolescents have strong emotions that they should be better prepared and helped to manage. To optimize perioperative care an interdisciplinary, a holistic approach must be taken that incorporates the complexity and whole of the adolescent's experiences. The findings of this study suggest that perioperative care of adolescents during scoliosis surgery needs to be optimized. To improve patients' psychologic preparation before surgery pediatric nurses should learn more about the individual patient and make care plans from a holistic perspective. Follow-up after discharge should address emotional, social, and physical aspects of the adolescent's health.
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