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Huhtala S, Palomaa AK, Tuomikoski AM, Pölkki T. Effectiveness of distraction-based interventions for relieving anxiety, fear, and pain in hospitalized children during venous blood sampling: a systematic review protocol. JBI Evid Synth 2024; 22:889-895. [PMID: 37921627 PMCID: PMC11081472 DOI: 10.11124/jbies-22-00057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
OBJECTIVE The aim of this review is to evaluate the effectiveness of active compared with passive distraction-based interventions for relieving anxiety, fear, and pain in hospitalized preschool and school-age children during venous blood sampling. INTRODUCTION Venous blood sampling remains the most common procedure that causes anxiety, fear, and pain among the pediatric population. It is important that health care professionals relieve a child's pain and the related emotions because untreated pain may have long-term effects on children's growth and development. It is necessary to determine which interventions are effective in relieving these outcomes in preschool and school-age children during blood sampling. INCLUSION CRITERIA This review will include randomized controlled trials and quasi-experimental studies that include active and passive distraction-based interventions for relieving hospitalized preschool and school-age children's anxiety, fear, and pain during venous blood sampling. METHODS CINAHL, PubMed, Scopus, and the Cochrane Library databases will be searched for published studies. MedNar, Google Scholar, and PsycEXTRA databases will be searched for in-progress and unpublished studies. Two independent researchers will perform critical appraisal and data extraction using the JBI methodology. Data describing randomized controlled trials and quasi-experimental studies will be pooled in a statistical meta-analysis. If statistical analysis is not possible, the findings will be reported narratively. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach will be used to assess certainty in the quality of evidence. REVIEW REGISTRATION PROSPERO CRD42023455617.
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Affiliation(s)
- Saija Huhtala
- Kajaani University of Applied Sciences, Kajaani, Finland
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, University Hospital and University of Oulu, Oulu, Finland
| | - Anna-Kaija Palomaa
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, University Hospital and University of Oulu, Oulu, Finland
- Oulu University Hospital, Oulu, Finland
| | - Anna-Maria Tuomikoski
- Medical Research Center Oulu, University Hospital and University of Oulu, Oulu, Finland
- Oulu University Hospital, Oulu, Finland
- Finnish Centre for Evidence-Based Health Care: A JBI Centre of Excellence, Nursing Research Foundation, Helsinki, Finland
| | - Tarja Pölkki
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, University Hospital and University of Oulu, Oulu, Finland
- Finnish Centre for Evidence-Based Health Care: A JBI Centre of Excellence, Nursing Research Foundation, Helsinki, Finland
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Söderbäck M. Young (3–5 year-old) children’s ways of engagement in care procedures involving venepuncture. J Res Nurs 2012. [DOI: 10.1177/1744987111434191] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
A fear of medical examination and of pain in care procedures is common among children. Young children are particularly sensitive to the way a procedure is carried out. The children will engage and act in the way they understand the situation and what is meaningful for them, which will depend on their experiences, interests and motivation. This study describes the qualitative differences in the complexity of how young children, aged 3–5 years, demonstrated the way they engaged in care procedures involving venepuncture. Video observation captured the young children as social actors in the procedure, and interpretive descriptive analysis was used to seek an understanding of the children’s demonstrated expressions and actions. The identified ways of engagement among the children were as follows: watchful engagement, curious engagement and adaptive engagement, as well as avoidance, forced engagement and resigned engagement. The children could fluctuate between the different ways of engagement during the course of the procedure. The results call attention to the sensitivity and responsiveness shown by the adults, nurses and parents in guiding the young children’s engagement and their ability to become integrated and act through active participation in a sometimes frightening care procedure.
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Affiliation(s)
- Maja Söderbäck
- Associate Professor, School of Health, Care and Social Welfare, Mälardalen University, Sweden
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Harder M, Christensson K, Coyne I, Söderbäck M. Five-year-old children's tuning-in and negotiation strategies in an immunization situation. QUALITATIVE HEALTH RESEARCH 2011; 21:818-829. [PMID: 21343432 DOI: 10.1177/1049732311400629] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
In this article, we have explored 5-year-old children's expressions when they as actors took part in an immunization situation in the Primary Child Health Care (PCHC) service in Sweden. Although children's health and development are the main concern in the PCHC service, their perspectives in such a setting have not been explored fully. To capture children's perspectives we used a hermeneutic design and video observations. The findings revealed children as competent and active participants, contributing to the construction of the PCHC situation in mutuality with the nurse and the parent. The conceptualization of children's expressions and actions revealed how they influenced and dealt with a PCHC situation by using strategies of tuning-in, affirmative negotiation, and delaying negotiation. Understanding children's actions will assist nurses to act with sensitivity when they encounter and support children.
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Kortesluoma RL, Nikkonen M, Serlo W. “You Just Have to Make the Pain Go Away”—Children's Experiences of Pain Management. Pain Manag Nurs 2008; 9:143-9, 149.e1-5. [DOI: 10.1016/j.pmn.2008.07.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Abstract
BACKGROUND Previous studies have focused on children's views of sources of pain and only secondarily explored their views on pain-relief strategies. METHODS An exploratory cross-sectional descriptive design and 'draw and write' technique were used to investigate what children think helps them when they have pain. RESULTS The sample (n = 71) was comprised of 33% boys and 67% girls, with an age range of 4-16 years (mean +/- SD: 9.25 +/- 3.04). Four overarching themes were derived that were common to both the texts and drawings: 'People who help', 'What I do that helps', 'What other people do that helps' and 'Things that help'. Children also described their emotional reactions to pain or pain relief. Multiple themes were represented in most of the texts and drawings. There were few differences in the themes present in the children's texts and drawings based on developmental age and no differences based on gender. CONCLUSIONS Children across the three developmental age groups view themselves as active agents in pain relief. Although less than half of the children described specific behaviours they had taken, almost all children indicated their active role as the central figure in relation to use of objects or the actions of others.
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Affiliation(s)
- L S Franck
- lnstitute of Child Health, University College London, London, UK.
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Abstract
The aim of this study was to investigate how small boys between 3 and 6 years of age describe bodily and verbal expressions of postoperative symptoms. The data collection was carried out at a large general hospital in Sweden and included both participant observations and semistructured interviews. The results provided a description of how 3- to 6-year-old boys bodily and verbally express postoperative symptoms. The results also showed that small children have difficulties in distinguishing pain, nausea, and anxiety and that postoperative discomfort was experienced in many different ways.
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Earhart A, Jorgensen C, Kaminski D. Assessing Pediatric Patients for Vascular Access and Sedation. JOURNAL OF INFUSION NURSING 2007; 30:226-31. [PMID: 17667078 DOI: 10.1097/01.nan.0000281532.04808.1d] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Central venous catheters have been established as a reliable source of vascular access since the 1970s. Peripherally inserted central catheters became a popular central catheter in the early 1990s for adults and children. The management of vascular access in children is an essential part of inpatient and outpatient care. Assessing and inserting the appropriate catheter for the pediatric patient is just a part of the component for central catheter care. Care providers also need to assess these children for sedation or distraction for the procedure. This article discusses factors for catheter choice and points for assessing children for sedation or distraction for vascular access insertion.
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Affiliation(s)
- Ann Earhart
- Vascular Access Team, Banner Desert Medical Center, Mesa, AZ 85202, USA
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Kortesluoma RL, Nikkonen M. 'I had this horrible pain': the sources and causes of pain experiences in 4- to 11-year-old hospitalized children. J Child Health Care 2004; 8:210-31. [PMID: 15358886 DOI: 10.1177/1367493504045822] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Researchers have relied, almost without exception, on adults for qualitative information about children's pain. However, adults may provide only a limited view of children's pain experience. The purpose of this article is to describe the events considered painful by children. Forty-four children participated in the study. They had been admitted for different reasons into different wards of a university hospital. The data consisted of qualitative child interviews and was analysed using inductive content analysis. The pain experience of children came from four main sources: 1. pain as a symptom of a diagnosed illness, 2. pain caused by medical and diagnostic procedures and basic nursing, 3. pain caused by accidents and 4. inexplicable pain not caused by a particular illness or injury. Children are able to report and describe their pain. Children should be regarded as experts on their pain in order to maximize the options for pain management.
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Breau LM, MacLaren J, McGrath PJ, Camfield CS, Finley GA. Caregivers' Beliefs Regarding Pain in Children With Cognitive Impairment: Relation Between Pain Sensation and Reaction Increases With Severity of Impairment. Clin J Pain 2003; 19:335-44. [PMID: 14600533 DOI: 10.1097/00002508-200311000-00001] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine whether caregivers of children with cognitive impairment (CI) have systematic beliefs regarding the pain of this special group of children and whether these beliefs are related to their general attitudes towards people with mental challenges, or their experience with, or knowledge about, children with CI . PARTICIPANTS Sixty-five caregivers (52 parents and 13 health care providers) of children with significant CI. MEASURES Caregivers completed the Mental Retardation Attitude Inventory-Revised and provided information regarding their previous experience and learning about children with CI. They also completed the Pain Opinion Questionnaire, indicating the percentage of children with mild, moderate, or severe/profound CI that they believe experience 5 facets of pain "less than", "the same as", or "more than" children without CI: sensation, emotional reaction, behavioral reaction, communication, and frequency. RESULTS Caregivers believed children's pain Sensation becomes greater, relative to children without CI, as severity of CI increases and that pain reaction is most consistent with pain sensation for children with severe CI. They also believed children with mild CI may over-react to pain. Caregivers' beliefs regarding pain were not influenced by their general attitudes about people with mental challenges or by their experience with children with CI, but those with more learning regarding children with CI believed that they experience pain less than children without CI. CONCLUSIONS Caregivers have a priori beliefs regarding pain in children with CI that vary with level of cognitive impairment and pain facet. These beliefs could impact children's care.
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Affiliation(s)
- Lynn M Breau
- Department of Psychology, Dalhousie University, Nova Scotia, Canada.
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Pölkki T, Pietilä AM, Vehviläinen-Julkunen K. Hospitalized children's descriptions of their experiences with postsurgical pain relieving methods. Int J Nurs Stud 2003; 40:33-44. [PMID: 12550148 DOI: 10.1016/s0020-7489(02)00030-5] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The purpose of this study was to describe children's (aged 8-12 yr) experiences with postsurgical pain relieving methods, and their suggestions to nurses and parents concerning the implementation of pain relief measures in the hospital. The data were collected by interviewing children (N = 52) who were inpatients on a pediatric surgical ward in the university hospital of Finland. Content analysis was used to analyze the data. The children rated the intensity of pain on a visual analogue scale. The results indicated that all of the children used at least one self-initiated pain relieving method (e.g. distraction, resting/sleeping), in addition to receiving assistance in pain relief from nurses (e.g. giving pain killers, helping with daily activities) and parents (e.g. distraction, presence). The children also provided suggestions, especially as it relates to nurses (e.g. creating a more comfortable environment), regarding the implementation of effective surgical pain relief. However, some cognitive-behavioral and physical methods were identified that should be implemented more frequently in clinical practice. Furthermore, most children reported their worst pain to be severe or moderate, which indicates that pain management in hospitalized children should be more aggressive.
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Affiliation(s)
- Tarja Pölkki
- Department of Nursing Science, University of Kuopio, PO Box 1627, 70211 Kuopio, Finland.
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Pölkki T, Pietilä AM, Rissanen L. Pain in children: qualitative research of Finnish school-aged children's experiences of pain in hospital. Int J Nurs Pract 1999; 5:21-8. [PMID: 10455613 DOI: 10.1046/j.1440-172x.1999.00151.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of the study was to describe school-aged children's experiences of pain in the hospital. Data were collected from 20 children aged between seven and 11 years of age who were inpatients in the pediatric wards of the University Hospital, Oulu, Finland. Each of the children wrote of their experiences of pain in the hospital, and they were interviewed on the basis of this information. The data were analyzed inductively using content analysis. On the basis of the analysis, the situations that caused pain to all children in the hospital were found to be procedures connected with needles. The children described their experiences of pain as both physiological (e.g. poking, stinging, aching) and psychological feelings (unpleasant feelings, terror, anxiety, and fear). In addition, methods of relieving pain (coping mechanisms, help from the medical staff, parental presence, and previous experiences of similar situations) were acknowledged. The results indicate that school-aged children (aged 7-11 years) are able to describe their pain experiences, which should be considered in assessment and treatment of children's pain in nursing practice.
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Affiliation(s)
- T Pölkki
- Department of Nursing Science, University of Kuopio, Finland
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Woodgate R, McClement S. Symptom distress in children with cancer: the need to adopt a meaning-centered approach. J Pediatr Oncol Nurs 1998; 15:3-12. [PMID: 9473888 DOI: 10.1177/104345429801500102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Children with cancer experience many symptoms during the course of their illness trajectory. However, to date, research capturing the total symptom experience in this population and the language used by children to express distress is lacking. This article reviews the theoretical and empirical underpinnings of symptom distress in children with cancer including discussion related to (1) medical procedures, (2) cancer treatment, and (3) children's adjustment to cancer. Recommendations for research and practice that will provide a foundation for understanding children's experience with symptom distress are also included. Most salient of those recommendations is to adopt a meaning-centered approach to guide research and practice. This includes capturing the meanings and feelings children assign to the symptoms they experience throughout the whole illness trajectory.
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Affiliation(s)
- R Woodgate
- University of Manitoba, Winnipeg, Canada
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