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Gong L, Xiang D. Comment on: Effectiveness of clown intervention for pain relief in children: A systematic review and meta-analysis. J Clin Nurs 2024; 33:1219-1220. [PMID: 37788051 DOI: 10.1111/jocn.16892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 09/20/2023] [Indexed: 10/04/2023]
Affiliation(s)
- Lin Gong
- Department of Pediatric Surgery, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, China
| | - Dongzhou Xiang
- Department of Pediatric Surgery, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, China
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2
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Kristensen HN, Laugesen B, Stinson J, Haslund-Thomsen H. The Impact and Influence of Hospital Clowns on Hospitalized Children Undergoing Painful Procedures: A Mixed Methods Study. Glob Qual Nurs Res 2023; 10:23333936231186599. [PMID: 37538194 PMCID: PMC10395183 DOI: 10.1177/23333936231186599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 08/05/2023] Open
Abstract
Hospital clowns are widely used in pediatric settings. However, the field of pain and pain experience in children is complex and multifaceted. Therefore, the aim of this study was to expand knowledge on the impact and influence of hospital clowns on 4 to 15-year-old children's experiences of managing painful procedures and conditions. A convergent mixed method study was conducted integrating findings from three individual studies: a prospective non-blinded study and two focused ethnographic studies. The findings illuminated a child-clown interaction characterized by a close relationship evolving during a continuous, mutually focused attention, conceptualized as WE. This WE represent a responsive interaction between child and clown, which supported the child during the procedures, and generated three integrated findings: an age-differentiated approach; understanding the child's condition; and previous experiences as a part of the child's history. The WE approach strengthened the child's competences and ability to manage during painful procedures.
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Affiliation(s)
| | - Britt Laugesen
- Aalborg University Hospital, Denmark
- Aalborg University, Denmark
| | - Jennifer Stinson
- University of Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
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3
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Karnieli-Miller O, Divon-Ophir O, Sagi D, Pessach-Gelblum L, Ziv A, Rozental L. More Than Just an Entertainment Show: Identification of Medical Clowns' Communication Skills and Therapeutic Goals. QUALITATIVE HEALTH RESEARCH 2023; 33:25-38. [PMID: 36384326 PMCID: PMC9827496 DOI: 10.1177/10497323221139781] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Medical clowns (MCs) are trained professionals who aim to change the hospital environment through humor. Previous studies focused on their positive impact and began identifying their various skills in specific situations. When placed in pediatrics, MCs face various challenges, including approaching frustrated adolescents who are unwilling to cooperate with their care, dealing with their anxious parents, and communicating in a team in the presence of other health professionals. Research that systematically describes MCs' skills and therapeutic goals in meeting these challenges is limited. This article describes a qualitative, immersion/crystallization study, triangulating between 26 video-recorded simulations and 12 in-depth-semi-structured interviews with MCs. Through an iterative consensus-building process we identified 40 different skills, not limited to humor and entertainment. Four main therapeutic goals emerged: building a relationship, dealing with emotions, enhancing a sense of control, caring, and encouragement, and motivating treatment adherence. Mapping MCs' skills and goals enhances the understanding of MCs' role and actions to illustrate their unique caring practices. This clarification may help other healthcare professionals to recognize their practices and the benefits in involving them in care. Furthermore, other health professionals may apply some of the identified skills when faced with these challenges themselves.
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Affiliation(s)
| | | | | | | | - Amitai Ziv
- Tel Aviv
University, Tel Aviv, Israel
- Sheba Medical
Center, Israel
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4
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Fusetti V, Re L, Pigni A, Tallarita A, Cilluffo S, Caraceni AT, Lusignani M. Clown therapy for procedural pain in children: a systematic review and meta-analysis. Eur J Pediatr 2022; 181:2215-2225. [PMID: 35294645 DOI: 10.1007/s00431-022-04440-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/07/2022] [Accepted: 03/07/2022] [Indexed: 12/16/2022]
Abstract
UNLABELLED Among the distraction techniques used for the non-pharmacological management of acute pediatric pain, one of the most performed is clown therapy. Despite the presence in the literature of some systematic reviews that evaluate its effectiveness, none of them examines its outcomes on procedural pain which has therefore been investigated in this study. The literature search for randomized controlled trials (RCTs) was performed on the Cochrane Library, MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, and Scopus over a time frame ranging from each database setup date to 31 July 2021. The primary outcome was the procedural pain of children. We used the Cochrane Risk of Bias tool to assess the risk of bias of the included studies. Six RCTs were selected for this review, which included a total of 517 pediatric subjects. Children undergoing clown therapy during the venipuncture or peripheral vein cannulation procedure reported less pain than those exposed to the standard of care (SMD = -0.55; 95% CI: -1.23, 0.13) but the result was not found to be statistically significant. School-aged children and adolescent reported significantly less pain (SMD = -0.51; 95% CI: -0.92, -0.09). Compared to the standard of care, children's anxiety was significantly lower with clown therapy (SMD = -0.97; 95% CI: -1.38, -0.56). CONCLUSION Clown therapy seems effective in reducing procedural pain in children, particularly for older age groups, but due to poor methodological quality and the high risk of bias of the studies included, the results obtained should be considered with caution. WHAT IS KNOWN • Clown therapy is one of the most used techniques in the non-pharmacological management of acute pediatric pain. • Laughter physiologically stimulates the production of beta-endorphins, substances with an effect similar to opiates. WHAT IS NEW • Clown therapy seems effective in reducing procedural pain and anxiety in children. • The intervention in school-age children or adolescents produces a statistically significant decrease in the symptom.
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Affiliation(s)
- Viviana Fusetti
- Pain Therapy and Rehabilitation Unit, Palliative Care, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.
- Università Degli Studi di Roma, Tor Vergata, Roma, Italy.
| | - Luca Re
- Bachelor School of Nursing, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Università Degli Studi Di Milano, Milan, Italy
| | - Alessandra Pigni
- Pain Therapy and Rehabilitation Unit, Palliative Care, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Antonino Tallarita
- Pain Therapy and Rehabilitation Unit, Palliative Care, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Silvia Cilluffo
- Bachelor School of Nursing, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Università Degli Studi Di Milano, Milan, Italy
| | - Augusto Tommaso Caraceni
- Pain Therapy and Rehabilitation Unit, Palliative Care, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
- Università Degli Studi Di Milano, Milan, Italy
| | - Maura Lusignani
- Bachelor School of Nursing, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Università Degli Studi Di Milano, Milan, Italy
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5
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Robbertz AS, Shneider C, Cohen LL. The role of nursing student training status and anxiety in pediatric pain assessment. CHILDRENS HEALTH CARE 2022. [DOI: 10.1080/02739615.2022.2051512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
| | - Caitlin Shneider
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Lindsey L. Cohen
- Department of Psychology, Georgia State University, Atlanta, GA, USA
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6
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Gürdap Z, Cengiz Z. Comparison of cold spray and shotblocker to reduce intramuscular injection pain: A randomized controlled trial. J Clin Pharm Ther 2022; 47:1249-1256. [PMID: 35385141 DOI: 10.1111/jcpt.13663] [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: 01/18/2022] [Revised: 03/17/2022] [Accepted: 03/28/2022] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE It is important to identify effective, easy-to-use and cost-effective non-pharmacological methods in the management of pain caused by medical interventions. The purpose of this study is to compare the effects of cold spray and ShotBlocker on pain in adults in reducing pain caused by intramuscular injection in the adult emergency department. METHODS This is a randomized controlled trial with two experimental groups, two placebo groups and a control group. The study was conducted on 195 adults who received diclofenac sodium injections. In the study, the injection procedure was performed by following the same injection protocol in all five groups. In the injection process, cold spray or ShotBlocker was used in the intervention groups based on the group, and cold spray with distilled water or the smooth surface of the ShotBlocker was used in the placebo groups. Following the injection, the pain caused by the injection was evaluated using the Visual Analog Scale. RESULTS AND DISCUSSION The study was completed with the remaining 195 patients. In the study, the average pain scores due to injection of the individuals in the cold spray group were lower than those of the control group (p < 0.05). There was no statistically significant difference between the pain score averages due to injection of the individuals in the ShotBlocker group and cold spray, control, ShotBlocker placebo and cold spray placebo groups. WHAT IS NEW AND CONCLUSION The routine use of a fast-acting, cost-effective and easy-to-use method, cold spray, to reduce pain in the intramuscular injection will be beneficial in increasing patient satisfaction and quality of care.
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Affiliation(s)
- Züleyha Gürdap
- Department of Fundamentals of Nursing, Nursing Faculty, Inonu University, Malatya, Turkey
| | - Zeliha Cengiz
- Department of Fundamentals of Nursing, Nursing Faculty, Inonu University, Malatya, Turkey
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Kurudirek F, Arikan D, Sarialioğlu A. Effects of therapeutic clowning on pain and anxiety during venous blood sampling in Turkey: Randomised controlled trial. J SPEC PEDIATR NURS 2021; 26:e12352. [PMID: 34216423 DOI: 10.1111/jspn.12352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/18/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The research aim was to investigate the effects of therapeutic clowning on pain and fear during the process of venous blood sampling in children. DESIGN AND METHODS This study was conducted in a randomised controlled trial from January to March 2020. The study population consisted of children from 7 to 12 years of age who came to the research centre for blood sampling. The research sample consisted of 166 children (83 in the intervention group and 83 in the control group) who met the research criteria and came to the research centre on a specific date through probable sampling. For the data collection, a questionnaire form, the Visual Analogue Scale and the Children's Fear Scale were used. Therapeutic clowning was used in this process for the intervention group. There was no intervention for children who were in the control group. The calculation of percentage distribution and means, χ2 test, analysis of variance analysis in repeated measures and least significant difference and independent t-test were used to analyse the data. RESULTS The results of the research indicated that children in the intervention group had significantly lower pain and fear than children in the control group (p < .001). Therapeutic clowning seems to effectively reduce pain and fear during venous blood sampling for children from 7 to 12 years of age. Our results support using therapeutic clowns which is an inexpensive, safe, and effective method for lowering children's pain and fear during venous blood sampling. PRACTICE IMPLICATIONS The use of therapeutic clowns could become the standard of care in blood sampling for children from 7 to 12 years of age in hospitals. Therapeutic clowning, which is an easy-to-use, low-cost and practical method to provide better communication and cooperation with the family and the child, can be used as a complementary therapy in all nursing areas, especially in the field of paediatrics. Nurses could be encouraged to be trained on the use of therapeutic humour based upon a standardised approach and offered guidance on how to apply entertaining methods such as clowns. Therapeutic clowning can be examined in other applications in nursing care in light of these results.
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Affiliation(s)
- Fatma Kurudirek
- Department of Child Health and Diseases Nursing, Faculty of Nursing, Ataturk University, Erzurum, Turkey
| | - Duygu Arikan
- Department of Child Health and Diseases Nursing, Faculty of Nursing, Ataturk University, Erzurum, Turkey
| | - Arzu Sarialioğlu
- Department of Child Health and Diseases Nursing, Faculty of Nursing, Ataturk University, Erzurum, Turkey
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Epstein Rigbi N, Schwartz N, Goldberg MR, Levy MB, Nachshon L, Elizur A. Medical clown support is associated with better quality of life of children with food allergy starting oral immunotherapy. Pediatr Allergy Immunol 2021; 32:1029-1037. [PMID: 33452829 DOI: 10.1111/pai.13445] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/23/2020] [Accepted: 12/28/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The start of oral immunotherapy (OIT) for food allergy is a critical period in the treatment process, with a potential to influence patient quality of life (QOL) and subsequently treatment outcome. The association of medical clowning with QOL at OIT initiation was examined. METHODS Children aged 4-12 years supported by a medical clown (MC) during the induction week of OIT for food allergy were studied. Children in the same age range starting OIT without the support of a MC served as controls. Parents of all children completed the Food Allergy Quality of Life Questionnaire-Parent Form (FAQLQ-PF), and children aged 8-12 years completed the Food Allergy Quality of Life Questionnaire-Child Form (FAQLQ-CF). QOL scores of parents and children with and without a MC support were compared. RESULTS Children with (n = 88) and without (n = 212) the support of a MC were comparable in demographics and clinical characteristics. The study group had a significantly lower single highest tolerated dose compared to controls (57 ± 83 vs 162 ± 274 mg protein, respectively, P < .001). Parental perception of the QOL of children was not associated with a MC support (P = .81) but rather with previous reaction severity (P < .01). In contrast, the QOL of children aged 8-12 years (n = 119) was positively associated primarily with a MC support, total score 3.7 ± 1.1 vs 4.6 ± 1.3 (P < .001). CONCLUSIONS While the perception of QOL of parents of children with food allergy at OIT initiation is mainly associated with previous reaction severity, the QOL of the children themselves is primarily positively associated with MC support.
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Affiliation(s)
- Naama Epstein Rigbi
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (Former Assaf Harofeh) Medical Center, Zerifin, Israel.,Department of Pediatrics, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Naama Schwartz
- School of Public Health, Haifa University, Haifa, Israel
| | - Michael R Goldberg
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (Former Assaf Harofeh) Medical Center, Zerifin, Israel.,Department of Pediatrics, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael B Levy
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (Former Assaf Harofeh) Medical Center, Zerifin, Israel
| | - Liat Nachshon
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (Former Assaf Harofeh) Medical Center, Zerifin, Israel.,Department of Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arnon Elizur
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (Former Assaf Harofeh) Medical Center, Zerifin, Israel.,Department of Pediatrics, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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9
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Ustuner Top F, Kuzlu Ayyıldız T. Pain management in children during invasive procedures: A randomized clinical trial. Nurs Forum 2021; 56:816-822. [PMID: 34053097 DOI: 10.1111/nuf.12616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/12/2021] [Accepted: 05/17/2021] [Indexed: 11/27/2022]
Abstract
AIMS This study was performed to determine the effect of distraction technique that was applied to 4-6-year-old children during blood drawal for decreasing the pain of the child during the procedure. MATERIAL AND METHODS The study was carried out as randomized controlled trial. Data were collected by individual information form, Faces Pain Scale-Revised (FPS-R), and a timer. Virtual reality glasses were used for distraction in the study. RESULTS Pain intensity and duration of crying significantly differed between the control and experimental groups. During the procedure, mean score of the children in the experimental group from "faces pain scale" was found to be 3.82 ± 1.20; the control group from "faces pain scale" was found to be 6.96 ± 2.08; and statistically significant differences were detected between both groups (p = 0.0001 and p = 0.001, respectively). When their duration of crying was examined, it was determined that mean crying time among the children in the experimental group was 8.43 ± 12.42 s and it was 33.65 ± 24.02 s among the children in control group; and the difference between groups was found to be statistically significant. CONCLUSION It was detected that using virtual reality glasses was an effective method in decreasing pain of the children during blood drawal procedure.
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Affiliation(s)
- Fadime Ustuner Top
- Department of Pediatric Nursing, Faculty of Health Sciences, Giresun University, Giresun, Turkey
| | - Tülay Kuzlu Ayyıldız
- Department of Pediatric Nursing, Faculty of Health Sciences, Bülent Ecevit University, Zonguldak, Turkey
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10
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Kyriakidis I, Tsamagou E, Magos K. Play and medical play in teaching pre-school children to cope with medical procedures involving needles: A systematic review. J Paediatr Child Health 2021; 57:491-499. [PMID: 33710698 DOI: 10.1111/jpc.15442] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 02/13/2021] [Accepted: 02/28/2021] [Indexed: 11/29/2022]
Abstract
AIM Most toddlers experience pain and distress during doctor or dental visits. Aim of this systematic review was to investigate the role of play-based interventions in pain and fear or distress management in pre-school children (aged from 2 to 6 years old) undergoing needle-related medical procedures adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (registration number: CRD42020192161). METHODS The key database that was searched was PubMed/MEDLINE along with references of relevant review studies. Only randomised controlled trials (RCTs) that fulfilled inclusion and eligibility criteria were selected for analysis. Methodological quality was evaluated using the Cochrane Collaboration's Risk of Bias Tool for RCTs and Review Manager version 5.4 was utilised in order to calculate standardised mean differences (SMDs) and create a forest plot for included studies that presented data on self-reported pain ratings. Primary outcomes refer to pain, anxiety and fear assessments, while secondary outcomes refer to physiological measures and cortisol levels. RESULTS All included RCTs suffered from high risk of bias that relied on selection and blinding methodology, while other sources of bias were also present in some cases. Despite low-quality of evidence, play-based interventions seem to favour less self-reported pain (SMD -0.39; 95% CI: -0.67 to -0.12; I2 = 84%). CONCLUSION Limitations of evidence, except from high risk of bias, include inconsistency in reporting primary outcome assessments and study designs that preclude reproducibility. Play-based techniques seem to contribute to pre-schoolers' coping towards needle-related medical procedures and further research is warranted in order to explore clinical benefits.
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Affiliation(s)
- Ioannis Kyriakidis
- Hematology Oncology Unit, Second Pediatric Department, Aristotle University of Thessaloniki, University General Hospital AHEPA, Thessaloniki, Greece.,Department of Pediatrics, 404 General Military Hospital, Larissa, Greece
| | - Evangelia Tsamagou
- Department of Early Childhood Education, School of Humanities and Social Sciences, University of Thessaly, Volos, Greece
| | - Konstantinos Magos
- Department of Early Childhood Education, School of Humanities and Social Sciences, University of Thessaly, Volos, Greece
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Galai T, Yerushalmy-Feler A, Heller NP, Ben-Tov A, Weintraub Y, Amir A, Moran-Lev H, Zac L, Cohen S. Age and pain score before gastrointestinal endoscopies in children are predictors for post procedure pain. BMC Gastroenterol 2020; 20:400. [PMID: 33243150 PMCID: PMC7689973 DOI: 10.1186/s12876-020-01546-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 11/18/2020] [Indexed: 12/31/2022] Open
Abstract
Background Gastrointestinal endoscopy may be associated with pain and anxiety. Predictors for high pain scores after endoscopies in children are not known. The aim of our study was to identify risk factors for prolonged recovery and higher pain scores after gastrointestinal endoscopy in children. Methods All the children that were electively admitted for gastrointestinal endoscopies were included. We retrospectively collected demographic, clinical and endoscopic data as well as information on the recovery process. A numerical rating scale and the Faces, Legs, Activity, Cry, and Consolability Scale were used for pain scoring. Results During the study period (01/2016–10/2016), 284 children (median age 10.7 years, interquartile range 6.7–14.8) were recruited. In a univariate analysis, older age, higher pre-procedure pain scores, longer procedure durations, higher number of biopsies and longer recovery duration were associated with higher post-procedure pain scores. In a multivariate analysis higher pain scores before the procedure (OR 12.42, 95% CI 3.67–42, P < 0.001) and older age (OR 1.016, 95% CI 1.007–1.025, P < 0.001) were associated with higher pain scores after the procedure. Children with a higher pain score before the procedure also had a longer recovery period (OR 5.28, 95% CI (1.93–14.49), P = 0.001). Conclusion Older age and higher pain score before the procedure were identified as predictors for higher pain score after pediatric gastrointestinal endoscopies. Children with these risk factors should be identified before the procedure in order to personalize their post-procedure management.
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Affiliation(s)
- Tut Galai
- Pediatric Gastroenterology Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Yerushalmy-Feler
- Pediatric Gastroenterology Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nathan P Heller
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Ben-Tov
- Pediatric Gastroenterology Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Weintraub
- Pediatric Gastroenterology Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Achiya Amir
- Pediatric Gastroenterology Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadar Moran-Lev
- Pediatric Gastroenterology Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lilach Zac
- Department of Anesthesiology and Critical Care, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomi Cohen
- Pediatric Gastroenterology Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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İnangil D, Şendir M, Büyükyılmaz F. Efficacy of Cartoon Viewing Devices During Phlebotomy in Children: A Randomized Controlled Trial. J Perianesth Nurs 2020; 35:407-412. [DOI: 10.1016/j.jopan.2020.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/12/2020] [Accepted: 01/18/2020] [Indexed: 10/24/2022]
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13
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Yildizeli Topcu S, Akgun Kostak M, Semerci R, Guray O. Effect of Gum Chewing on Pain and Anxiety in Turkish Children During Intravenous Cannulation: A Randomized Controlled Study. J Pediatr Nurs 2020; 52:e26-e32. [PMID: 31889572 DOI: 10.1016/j.pedn.2019.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 12/10/2019] [Accepted: 12/13/2019] [Indexed: 01/28/2023]
Abstract
PURPOSE Although gum chewing is a simple intervention that can be used for the management of pain and anxiety in the nursing care of children, few studies have assessed this intervention. This study aimed to investigate the effect of gum chewing on pain and anxiety during intravenous (IV) cannulation in children. DESIGN AND METHODS This randomized controlled study assessed 73 children aged 6 to 12 years in the general paediatric unit in a university hospital in the Trachy Region, Turkey from April to September 2017. In the experimental group, children chewed gum during the procedure. The standard care was applied to the control group. Data were collected via the Children's Anxiety Pain Scale and the Data Collection Form. RESULTS According to the children's self-report and the nurse's report, the pain level of the experimental group was significantly lower than the control group. Although no significant difference was noted between experimental and control groups' anxiety levels, nurses stated higher anxiety levels than children. CONCLUSIONS The IV cannulation procedure causes pain and anxiety in children. Nurses reported the perception of a higher level of anxiety during the procedure than the children actually experienced. Gum chewing might reduce pain during IV cannulation. Nurses should consider using gum chewing as a simple nursing implementation to increase the effects of other pharmacological and non-pharmacological techniques for management of children's procedural pain. PRACTICE IMPLICATIONS Nurses who work with the children could use gum chewing as a simple, inexpensive, and pleasurable intervention for the management of pain.
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Affiliation(s)
- Sacide Yildizeli Topcu
- Trakya University, Faculty of Health Sciences, Department of Surgical Nursing, Edirne, Turkey.
| | - Melahat Akgun Kostak
- Trakya University, Faculty of Health Sciences, Department of Child Health and Disease Nursing, Edirne, Turkey
| | - Remziye Semerci
- Trakya University, Faculty of Health Sciences, Department of Child Health and Disease Nursing, Edirne, Turkey
| | - Ozlem Guray
- Trakya University, Health Practice and Research Center, Pediatric Surgery Service, Edirne, Turkey
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14
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Kristensen HN, Sørensen EE, Stinson J, Haslund‐Thomsen H. An ongoing WE: A focused ethnographic study of the relationship between child and hospital clown during recurrent pain‐related procedures and conditions. ACTA ACUST UNITED AC 2019; 1:5-14. [PMID: 35546867 PMCID: PMC8974843 DOI: 10.1002/pne2.12005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 06/19/2019] [Accepted: 07/19/2019] [Indexed: 11/29/2022]
Abstract
Aim This study explored the interaction between child and hospital clown during recurrent hospitalizations for repeated pain‐related procedures and conditions. Background Despite improvements in the management of pain in hospitalized children, procedural pain in particular is a common experience for hospitalized children, and they continue to report undertreated pain. Hospital clowns are widely used as a nonpharmacological intervention in hospitalized children. Little research has examined the influence of hospital clowns during recurrent hospitalizations on repeated painful procedures. Design and methods Ethnographic fieldwork using focused ethnography was conducted. Data were collected during October–December 2017 using participant observation and informal interviews with children at one pediatric unit at a Danish university hospital. Data include 61 interactions between children aged 4–14 years and hospital clowns. The participants comprised 13 children undergoing recurrent hospitalizations. The data were coded using thematic analysis, and the research team verified the resulting themes. Results The overarching theme was defined as An ongoing WE, based on two identified themes, that is, Stronger in a WE and Hope in the WE. The WE was characterized by a responsive interaction between the child and clown, which evolved over the course of an ongoing relationship. Conclusion This study demonstrates how an ongoing WE was constructed with children during repeated painful procedures and conditions. Specifically, the study emphasizes the importance of developing a trusting relationship on the child's terms. Children seemed to experience enhanced coping with painful procedures during the recurring hospital clown encounters, thus reinforcing their competence and hope for coping with future painful procedures. These findings may improve psychosocial care for hospitalized children undergoing repeated painful procedures and conditions and may facilitate multidisciplinary initiatives, such as nurses’ advocacy for the inclusion of hospital clowns during recurrent hospitalizations for repeated painful procedures to ensure optimal pain management.
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Affiliation(s)
- Helle Nygaard Kristensen
- Department of Pediatrics Aalborg University Hospital Aalborg Denmark
- Clinical Nursing Research Unit Aalborg University Hospital Aalborg Denmark
- Department of Clinical Medicine Aalborg University Aalborg Denmark
| | - Erik Elgaard Sørensen
- Clinical Nursing Research Unit Aalborg University Hospital Aalborg Denmark
- Department of Clinical Medicine Aalborg University Aalborg Denmark
| | - Jennifer Stinson
- Lawrence S. Bloomberg Faculty of Nursing University of Toronto Toronto ON Canada
- Child Health Evaluative Sciences, Research Institute The Hospital for Sick Children Toronto ON Canada
| | - Helle Haslund‐Thomsen
- Clinical Nursing Research Unit Aalborg University Hospital Aalborg Denmark
- Department of Clinical Medicine Aalborg University Aalborg Denmark
- Clinic for Anesthesiology Child Diseases, Circulation and Women Aalborg University Hospital Aalborg Denmark
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Kristensen HN, Sørensen EE, Stinson J, Thomsen HH. "WE do it together!" An Ethnographic Study of the Alliance Between Child and Hospital Clown During Venipunctures. J Pediatr Nurs 2019; 46:e77-e85. [PMID: 30935724 DOI: 10.1016/j.pedn.2019.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 03/13/2019] [Accepted: 03/18/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Hospital clowns are widely used as a means of non-pharmacological intervention in the treatment of hospitalized children. However, little research has examined the impact of clowns on common painful needle-related procedures. This study explored children's pain experience and their ability to cope during a venipuncture while interacting with a clown in the acute admission unit. DESIGN AND METHODS An ethnographic fieldwork study was conducted. Data were collected over a 10-month period through participant observation and informal interviews, supplemented by video recordings. The participants comprised 38 acutely admitted children aged 4 to 15 years undergoing a venipuncture in the presence of a hospital clown. Analysis was structured in three stages: before venipuncture; during venipuncture; and after venipuncture. RESULTS The development of a responsive interaction between child and clown, identified as a WE, was found to be beneficial to the child during venipuncture procedure. The WE was characterized by three themes "How do WE do this together?"; "WE are together"; and "I/WE did it!" CONCLUSIONS The study emphasizes the importance of a WE established between child and hospital clown from the first encounter until a final evaluation. This WE was verbalized repeatedly by the clown and the child and was essential in shaping a tailored approach which met the needs of each child. This approach seemed to strengthen the child's competence in pain management and ability to cope, thus building competence for future venipunctures. PRACTICE IMPLICATIONS Establishing a WE might advance the psychosocial care of hospitalized children undergoing acute painful procedures.
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Affiliation(s)
- Helle Nygaard Kristensen
- Department of Pediatrics, Aalborg University Hospital, Aalborg, Denmark; Clinical Nursing Research Unit, Aalborg University Hospital, Denmark; Department of Clinical Medicine, Aalborg University, Denmark.
| | - Erik Elgaard Sørensen
- Clinical Nursing Research Unit, Aalborg University Hospital, Denmark; Department of Clinical Medicine, Aalborg University, Denmark.
| | - Jennifer Stinson
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada; Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Helle Haslund Thomsen
- Clinical Nursing Research Unit, Aalborg University Hospital, Denmark; Department of Clinical Medicine, Aalborg University, Denmark; Clinic for Anesthesiology, Child Diseases, Circulation, and Women, Aalborg University Hospital, Denmark.
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(Non) Pharmacological Modalities in Acute Procedural Pain. Clin J Pain 2019; 35:459. [DOI: 10.1097/ajp.0000000000000687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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