Use of a projective technique to assess young children's appraisal and coping responses to a venipuncture

Undergoing an immunization is effortlessly, manageable or difficult according to five-year-old children

BACKGROUND

To prevent diseases among children they regularly undergo immunizations. Previous research show different approaches available to facilitate immunization-procedures for children to protect them from harm. To complement this research and provide care suited for children, research recognizing their perceptions of undergoing such a procedure is needed.

AIM

The aim of this study was to describe 5-year-old children's perceptions of undergoing an immunization.

METHOD

A phenomenographic approach and analysis was used to describe the children's (n = 21) various perceptions. The data-collection was accomplished directly after the immunization to grasp the children's immediate perceptions. Drawings and reflective talks were used as they are considered as suitable methods when involving young children in research. The right to conduct research with children was approved by the appropriate research ethics committee and also by each child and the parents.

RESULTS

The findings show that children's perceptions of an immunization-procedure may vary from effortlessly, to manageable or difficult. Regardless of how the child perceive the immunization-procedure each perception embrace the children's descriptions of actors and articles in the situation, their feelings in the situation and also their actions to deal with the immunization. Nevertheless, these descriptions vary according to how the children perceive the immunization as effortlessly, manageable or difficult.

CONCLUSION

Children's and adults' perceptions of medical procedures may differ and children need guidance, time and space to deal with them. Recognizing children's perceptions of undergoing an immunization contributes to the promotion of their right to be involved in their own health care and towards the development of child-centred care.

Nurses' encounters with children in child and school health care: negotiated guidance within a given frame

BACKGROUND

Throughout childhood, children take part in health visits according to a health-monitoring programme. The visits are aimed to promote the children's development and health and to strengthen them to take own responsibility for their health. Nurses' actions when encountering children at these visits are not explored to any great extent. Exploring nurses' actions can facilitate their reflections on their actions towards children and thereby promote children's involvement in such visits.

AIM

The aim of this study was to explore nurses' actions when encountering children at health visits.

METHOD

A qualitative explorative design, based on 30 video recordings of health visits in child and school health care, was used in this study. These visits were ordinary real-life health visits. The data were subjected to qualitative content analysis. The right to conduct video recordings during health visits was approved by appropriate research ethics committees.

RESULTS

The findings show that nurses, in order to carry out the health visits, encounter children through negotiated guidance. This guidance is understood as the process through which the nurses reach agreement with the children, and is comprised of directed and pliable strategies. At one moment, the nurse can use a directed strategy to inform the child and at the next moment a pliable strategy to provide the child space within the given frame, the health-monitoring programme. By using these strategies intertwined, the nurse can provide the child space within the given frame and, at the same time, fulfil his/her responsibility to promote children's health and development.

CONCLUSION

The results highlight nurses' challenging and complex assignment of guiding children to promote their engagement in the health visits, thereby enabling the nurses to promote the children's health and development according to the national health-monitoring programme.

A multifactorial strategy of pain management is associated with less pain in scheduled vaccination of children. A study realized by family practitioners in 239 children aged 4-12 years old

BACKGROUND AND AIMS

The multiplicity of vaccine injections during childhood leads to iterative painful and stressful experiences which may lead in turn to anticipated pain and then possibly to a true needle phobia. We aimed at evaluating a multifactorial strategy of pain management combining pharmacological and non-pharmacological approaches during vaccination, as compared to usual care, in 4- to 12-year-old children.

METHODS

In all, 239 children were enrolled by 25 family practitioners in an open-label study. After a pseudo-randomization, usual pain management (n = 132) was compared to a multifactorial strategy (n = 107) associating preliminary application of an anesthesic patch, preferential use of specified vaccines, child education by the parents and the doctor, parental accompaniment and child distraction with soap bubbles during the procedure. The primary outcome (i.e. child pain) was assessed with a self-report scale named visual analog scale (VAS) of pain.

RESULTS

A significant decrease in pain was obtained using the multifactorial strategy, as assessed by self-reported VAS (P < 0.0001). This was confirmed by another self-report scale (the facial pain scale revised: P = 0.005), as well as with hetero-evaluations by GPs and parents [Children's Hospital of Eastern Ontario Pain Scale: P = 0.0007; GPs VAS (P < 0.0001), parents VAS (P < 0.0001)], which were secondary outcome criteria.

CONCLUSIONS

This multifactorial method significantly decreases vaccination pain in 4- to 12-year-old children. This strategy could make vaccines more acceptable to children and may improve child-doctor relationships and contribute to a decrease in child fear about health care.

Parental holding and positioning to decrease IV distress in young children: a randomized controlled trial

Young children are generally restrained in supine position for IV starts, a position that creates fear but is presumed necessary. This study randomly assigned children of ages 9 months to 4 years (N = 118) to being held upright by a parent or lying flat on an exam table for their IV procedure. Distress scores as rated by the Procedure Behavior Rating Scale were significantly lower in the upright positioning group (p = .000); parents were more satisfied with the upright position, and the upright position did not significantly alter the number of IV attempts needed. The upright position appears to be an effective way to decrease IV distress in young children.

Taking the "ouch" out of injections for children. Using distraction to decrease pain

PURPOSE

This research compared the effect of two forms of distraction on injection pain in a convenience sample of preschool children.

DESIGN

A quasi-experimental study of 105 children (53 girls and 52 boys) ages 4 to 6 years needing DPT immunizations. Data were collected at three sites: two school-based immunization clinics and one public health center with a walk-in immunization program.

METHODS

Study children were randomly assigned to receive one of three treatments with their DTP injection: touch, bubble-blowing, or standard care. Prior to injection, a measure of medical fear was obtained (Child Medical Fear Scale) and pain was measured through use of the Oucher Scale.

DATA ANALYSIS

Planned comparisons within analysis of variance (ANOVA) tested the differences in pain scores by treatment. Factorial ANOVA was used to determine the influence of age or gender on treatment, and the effect of medical fear on pain was analyzed using correlational statistics and factorial ANOVA.

RESULTS

Both forms of distraction, touch and bubble-blowing, significantly reduced pain perception. There were no interaction effects of either age or gender. Fear was a significant covariate, but distraction was effective even when fear was not held constant.

CLINICAL IMPLICATIONS

Distraction appears to be an effective method for decreasing injection pain in young children. It is an easy, practical nursing intervention to help children cope with this common, painful experience.

Using distraction to reduce reported pain, fear, and behavioral distress in children and adolescents: a multisite study

ISSUES AND PURPOSE

Distraction during painful procedures has been shown to be effective in previous studies, yet this simple intervention is not used routinely. This study examined the effectiveness and feasibility of distraction in reducing behavioral distress, pain, and fear during venipuncture or intravenous insertion.

DESIGN AND METHODS

A two-group randomized design with 384 children in 13 children's hospitals.

RESULTS

Age was a significant factor in observed behavioral distress, reports of fear, and self-reported pain. The use of a kaleidoscope, however, did not significantly reduce pain or distress during venipuncture or i.v. insertion.

PRACTICE IMPLICATIONS

Failure of the distraction intervention to reach statistical significance in this study is puzzling, given anecdotal reports of clinical efficacy. Methodological issues may have obscured actual differences between experimental and control groups.