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Pope N, Jones S, Crellin D, Palmer G, South M, Harrison D. "Seeing the light in the shade of it": primary caregiver and youth perspectives on using an inpatient portal for pain care during hospitalization. Pain 2024; 165:450-460. [PMID: 37638836 DOI: 10.1097/j.pain.0000000000003039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/30/2023] [Indexed: 08/29/2023]
Abstract
ABSTRACT Studies from multiple countries report that most hospitalized children, especially the youngest and sickest, experience pain that is often severe yet inadequately treated. Evidence suggests this can lead to immediate and lifelong consequences affecting children, families, and communities. Partnership and shared decision-making by children, families, and clinicians is the ideal pediatric healthcare model and can improve care quality and safety, including pain care. A growing evidence base demonstrates that inpatient portals (electronic personal health record applications linked to hospital electronic medical or health records) can improve child and family engagement, outcomes, and satisfaction during hospitalization. This study examined the perspectives of caregivers of hospitalized children and of hospitalized youth about using an inpatient portal to support their engagement in pain care while in hospital. A qualitative descriptive study design was used and 20 participants (15 caregivers and 5 youth) with various painful conditions in one pediatric hospital participated in semistructured interviews. The authors applied a reflexive content analysis to the data and developed 3 broad categories: (1) connecting and sharing knowledge about pain, (2) user-centred designs, and (3) preserving roles. These findings outlined caregiver and youth recommendations for portal configurations that deeply engage and empower children and families in pain care through multidirectional knowledge sharing, supporting caregiver and clinicians' roles without burdening, or replacing human interaction implicit in family-centered pain care. Further research should measure the impact of portals on pain-related outcomes and explore the perspectives of clinicians.
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Affiliation(s)
- Nicole Pope
- The Royal Children's Hospital, Melbourne, Australia
- The University of Melbourne, Australia, Faculty of Medicine, Dentistry and Health Sciences, Department of Nursing
- The Murdoch Children's Research Institute, Melbourne, Australia
| | - Sophie Jones
- The Royal Children's Hospital, Melbourne, Australia
- The University of Melbourne, Australia, Faculty of Medicine, Dentistry and Health Sciences, Department of Nursing
- The Murdoch Children's Research Institute, Melbourne, Australia
| | - Dianne Crellin
- The Royal Children's Hospital, Melbourne, Australia
- The University of Melbourne, Australia, Faculty of Medicine, Dentistry and Health Sciences, Department of Nursing
- The Murdoch Children's Research Institute, Melbourne, Australia
| | - Greta Palmer
- The Royal Children's Hospital, Melbourne, Australia
- The University of Melbourne, Australia, Faculty of Medicine, Dentistry and Health Sciences, Department of Nursing
- The Murdoch Children's Research Institute, Melbourne, Australia
| | - Mike South
- The Royal Children's Hospital, Melbourne, Australia
- The University of Melbourne, Australia, Faculty of Medicine, Dentistry and Health Sciences, Department of Nursing
- The Murdoch Children's Research Institute, Melbourne, Australia
| | - Denise Harrison
- The Royal Children's Hospital, Melbourne, Australia
- The University of Melbourne, Australia, Faculty of Medicine, Dentistry and Health Sciences, Department of Nursing
- The Murdoch Children's Research Institute, Melbourne, Australia
- The University of Melbourne, Australia. Faculty of Medicine, Dentistry and Health Sciences, Department Paediatrics
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Segers EW, Ketelaar M, de Man MACP, Schoonhoven L, van de Putte EM, van den Hoogen A. How to support children to develop and express their coping preferences around minor invasive medical procedures: children's and parents' perspectives. Eur J Pediatr 2023; 182:5553-5563. [PMID: 37787922 PMCID: PMC10746775 DOI: 10.1007/s00431-023-05222-7] [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: 07/19/2023] [Revised: 09/14/2023] [Accepted: 09/16/2023] [Indexed: 10/04/2023]
Abstract
Invasive medical procedures in hospitals are major sources of stress in children, causing pain and fear. Non-pharmacological interventions are indispensable in effective pain and fear management. However, these interventions must be personalized to be effective. This qualitative study aims to gain insight into children's and parents' experiences, needs, and wishes related to supporting children to develop and express their coping preferences for dealing with pain and fear during minor invasive medical procedures in order to decrease pain and fear. A qualitative study using thematic analysis was performed. Data were collected through semi-structured interviews with children and parents who had undergone at least five minor invasive medical procedures in the last year. Nineteen children (8-18 years) and fourteen parents were interviewed individually. The experiences, needs, and wishes expressed in the interviews could be classified into one overarching theme, that of the personal process, and two content-related sub-themes: feeling trust and gaining control. The personal process was divided into two different phases, that of developing and of expressing coping preferences. Children and parents both reported it as a continuous process, different for every child, with their own unique needs. Children and parents expected personalized attention and tailored support from professionals. Conclusion: Professionals must combine clinical skills with child-tailored care. In the process of searching for and communicating about coping preferences, children's unique needs and personal boundaries will thereby be respected. This gives children and parents increased trust and control during invasive medical procedures. What is Known: • Untreated pain and stress caused by medical procedures can have severe and important short- and long-term consequences for children. Personalized non-pharmacological interventions are an essential element of procedural pain management. What is New: • A personalized coping strategy is important for children when undergoing medical procedures. Each individual child has a personal way of expressing their own coping strategy. Children and their parents need information and the space to develop and express their individual coping preferences. • Children and parents expect to receive child-tailored care from professionals including respect for their own, unique needs and boundaries. Professionals should build trustful relationships and provide appropriately tailored autonomy around medical procedures.
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Affiliation(s)
- Elisabeth W Segers
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB, Utrecht, The Netherlands.
| | - Marjolijn Ketelaar
- Center of Excellence for Rehabilitation Medicine, Brain Center University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Marjorie A C P de Man
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB, Utrecht, The Netherlands
| | - Lisette Schoonhoven
- Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Elise M van de Putte
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB, Utrecht, The Netherlands
| | - Agnes van den Hoogen
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, PO Box 85090, 3508 AB, Utrecht, The Netherlands
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Würtz G, Schmidt C, Jensen CS, Teilman G, Konradsen H. Pediatric pain knowledge and attitudes among health care professionals-A National Danish Survey. PAEDIATRIC & NEONATAL PAIN 2023; 5:76-85. [PMID: 37744283 PMCID: PMC10514779 DOI: 10.1002/pne2.12104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 02/05/2023] [Accepted: 03/23/2023] [Indexed: 09/26/2023]
Abstract
Aim To explore and compare Danish health-care professionals' attitudes and knowledge towards pain management of children. Methods The cross-sectional study was carried out using the Pediatric Pain Knowledge and Attitudes Questionnaire. The questionnaire was distributed to all health care professionals caring for children in three hospital settings, including nurses and physicians in departments of pediatric, emergency, and anesthesia and medical laboratory technologists. Results The study was conducted in 2020 and 765 health care professionals participated. Within the six main categories included in the questionnaire, there were significant differences between nurses and physicians in three subcategories: view on the care of children in pain, using drugs to relieve pain, and the four mandatories. Comparing nurses with medical laboratory technicians, there were significant differences in the subcategory "view on the care of children in pain." Comparing types of clinical departments, there were significant differences in the subcategories' view on the care of children in pain, using drugs to relieve pain, and the four mandatories. Overall, we found that the participating health professionals did not have a uniform understanding of pain management and therefore might treat children differently. Conclusion The present study highlights the need to align health care professionals' knowledge regarding pain assessment and management of children, as well as the need to develop and test interventions that support the use of knowledge in practice.
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Affiliation(s)
- Gitte Würtz
- Department of PediatricsHerlev and Gentofte University HospitalHerlevDenmark
| | - Christina Schmidt
- Department of PediatricsHerlev and Gentofte University HospitalHerlevDenmark
| | - Claus Sixtus Jensen
- Department of Pediatrics and Adolescent MedicineAarhus University HospitalAarhusDenmark
- Research Center for Emergency MedicineAarhus University HospitalAarhusDenmark
- Department of Clinical Medicine HealthAarhus UniversityAarhusDenmark
| | - Grete Teilman
- Department of Pediatrics and Adolescent Medicine, Nordsjællands HospitalUniversity of CopenhagenHillerødDenmark
| | - Hanne Konradsen
- Department of GastroenterologyHerlev and Gentofte University HospitalHerlevDenmark
- Division of Nursing, Department of Neurobiology, Care Science and SocietyKarolinska InstitutetStockholmSweden
- Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
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Menés Fernández L, Salvat I, Adillón C. Expressed Beliefs about the Cause of Pain in a Pediatric Population: A Qualitative Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1007. [PMID: 37371238 DOI: 10.3390/children10061007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/28/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023]
Abstract
(1) Background: The aims of this study are to explore what beliefs children and adolescents manifest about the cause of the pain they describe, to compare whether there are differences between beliefs by age and the persistence of pain, and to relate the explanations of the cause of pain with current scientific evidence. (2) Methods: a cross-sectional qualitative study was used. The primary endpoint of the study was obtaining explanations of the cause of pain recorded by means of an open-ended question. The participants were school-age children attending a charted school in the province of Barcelona. (3) Results: The children and adolescents proposed a diverse range of explanations for the cause of pain that they reported in their responses. The most frequent explanation for the cause of pain were pathologies and injuries (45.95%), ergonomic issues (22.60%) and psychological issues (15.95%). (4) Conclusions: There is a lot of variety in the explanations that young people give about the cause of their pain in schoolchildren aged between 10 and 16 years old. There exists a high prevalence of explanations non-associated with tissue damage (ENAD) concerning the causes of pain described. It is necessary that future health prevention programs dedicated to early ages consider which beliefs about the cause of pain are the most frequent in the pediatric population.
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Affiliation(s)
- Laura Menés Fernández
- Department of Medicine and Surgery, Faculty of Medicine and Health Sciences, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain
| | - Isabel Salvat
- Department of Medicine and Surgery, Faculty of Medicine and Health Sciences, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain
| | - Cristina Adillón
- Department of Medicine and Surgery, Faculty of Medicine and Health Sciences, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain
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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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Persson S, Warghoff A, Einberg E, Garmy P. Schoolchildren's experience of pain-A focus group interview study. Acta Paediatr 2021; 110:909-913. [PMID: 32716530 DOI: 10.1111/apa.15493] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/30/2020] [Accepted: 07/21/2020] [Indexed: 11/28/2022]
Abstract
AIM To explore the experience of pain in 10- to 12-year-old children. METHODS This interview study included students (n = 42) in grade 4-6 in focus groups (n = 10) in southern Sweden (52% girls); mean age, 11.3 years (range 10-12 years). The interviews were audio-recorded and transcribed verbatim and analysed with qualitative content analysis. RESULTS The analysis resulted in one theme: Pain as a unique experience for each individual, which was divided into five categories: (a) Feeling bodily pain; (b) Pain related to the school environment and schoolwork; (c) Internal pain related to sorrow and grief; (d) Pain related to conflicts and remorse; and (e) Pain can be good. CONCLUSION The children made distinctions between physical pain and emotional pain. Bullying, noisy school environments, grief and remorse were reported to be linked with headaches, stomachache and heartache.
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Affiliation(s)
- Sara Persson
- Faculty of Health Sciences Kristianstad University Kristianstad Sweden
| | | | - Eva‐Lena Einberg
- Faculty of Health Sciences Kristianstad University Kristianstad Sweden
| | - Pernilla Garmy
- Faculty of Health Sciences Kristianstad University Kristianstad Sweden
- Clinical Health Promotion Centre Medical Faculty Lund University Lund Sweden
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Nicholl A, Evelegh K, Deering KE, Russell K, Lawrence D, Lyons-Wall P, O’Sullivan TA. Using a Respectful Approach to Child-centred Healthcare (ReACH) in a paediatric clinical trial: A feasibility study. PLoS One 2020; 15:e0241764. [PMID: 33166989 PMCID: PMC7652280 DOI: 10.1371/journal.pone.0241764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 10/20/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND There is a growing momentum in paediatric ethics to develop respectful research and healthcare protocols. We developed, tested and refined our 'Respectful Approach to Child-centred Healthcare' (ReACH), to underpin respectful participant interactions in a clinical trial. OBJECTIVE To determine whether a ReACH-based approach is acceptable to children and parents, and effective in obtaining compliance with common healthcare assessments in a clinical trial of healthy 4-6-year-old children. METHODS ReACH-based child assessments were evaluated at two baseline clinics and one post-intervention, using mixed methods. Children (n = 49; 46.9% female; mean age = 5.24±0.88 years at baseline) and their parents provided independent evaluation, via customised 5-point Likert scales and qualitative feedback. A dedicated child researcher evaluated adherence to the study ReACH principles. RESULTS Children achieved compliance rates of 95% for body composition (BodPod) assessments; 89% for blood pressure measurements, and 92% (baseline) and 87% (post-intervention) for blood draws. Adherence to ReACH principles during clinic visits was positively associated with child compliance, significantly for baseline BodPod (p = 0.002) and blood test (p = 0.009) clinics. Satisfaction with BodPod protocols was positively associated with compliance, for children at baseline (p = 0.029) and for parents post-intervention (p <0.001). Parents rated the study itself very highly, with 91.7% satisfied at baseline and 100% post-intervention. Qualitative feedback reflected an enjoyable study experience for both parents and children. CONCLUSIONS Adherence to our emerging ReACH approach was associated with high child compliance rates for common healthcare assessments, although no causality can be inferred at this preliminary stage of development. Participants expressed satisfaction with all aspects of the study. Our use of child-centred methods throughout a research intervention appears feasible and acceptable to children and their parents.
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Affiliation(s)
- Analise Nicholl
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, Western Australia, Australia
| | - Kate Evelegh
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, Western Australia, Australia
| | - Kane Evan Deering
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, Western Australia, Australia
| | - Kate Russell
- Peaceful Parents, Confident Kids, Toowoomba, Queensland, Australia
| | - David Lawrence
- Faculty of Arts, Business, Law and Education, Graduate School of Education, University of Western Australia, Perth, Western Australia, Australia
| | - Philippa Lyons-Wall
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, Western Australia, Australia
| | - Therese Anne O’Sullivan
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, Western Australia, Australia
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